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lzhi <br />L'��j <br />City of Everett <br />Engineering Deparunent <br />Sewer Application and Permit <br />NO. 2109 11 DATE <br />Service Address _ _ _ Utility Account No <br />Billing Address Connection Permit Fee <br />City, State, Zip r/E / f Connection Fee _ <br />Owner (Mortgagor) Total Fee - <br />Billing Name sL <br />Connection BY__"/ <br />Signed <br />Customer <br />DESCRIPTION: Sewer District <br />Lot Monthly Sewer Service <br />Block <br />Division or Addition Monthly Sewer Constr. <br />Tn.n4 <br />a <br />SEE SKETCH ATTACHED <br />Abutting Lot Line <br />N,S,E,W <br />Approved By_ <br />City Engineer <br />Issued By <br />i <br />Inspection By a0 <br />Date I nspected r9 — 2 3 — % �� <br />NO. M77 <br />■ <br />