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111 <br />everett <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />NO. [ Q 8 2 4 DATE <br />Service. Address Utility Account No. <br />Billir;,ad tss i�/�— Connection Permit Fee c �' <br />City, Statu, Zips._. 77 iyi 1 Connection Fee <br />Owner (Mortgagor) r /4Z/f . t Total Fee <br />Billing Name lit.: <br />Cuuuediun By '� _ L.,% <br />Address <br />Phone_ <br />Signed <br />Cuftorner <br />DESCRIPTION: Sewer District <br />Lot <br />Block Monthly Sewer Service <br />Division or AdditionMonthly Sewer Constr, <br />SEE SKETCH ATTACHED <br />Trunk_ <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />City Engineer <br />Issued <br />Inspection By/&--)'-j OGt <br />)ate Inspected zii�l— Z Z — 7i <br />NO. <br />