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evetett <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />NO. 2081,� DATE <br />Service <br />r Utility Account No. 3.5SI Ws <br />s <br />Billing Address <br />i( i L Connection Permit Fee <br />City, State, Zip < / E �'L /t_ C ' ' Connection Fee — <br />//// <br />Owner (Mortgagor) �Gl/ Total Fee <br />Billing Name �,�A/ <br />Connection By <br />Address • :O /..L / Signed Customer <br />Phone --' <br />I <br />DESCRIPTION: Sewer Distract <br />Lot Monthly Sewer Service. <br />Block <br />Division or Addition r Monthly Sewer Constr. <br />Trunk <br />T,,n. Pnrmitt <br />SEE SKETCH ATTACHED <br />Abutting Lot Line <br />N,S,E,W <br />Approved By <br />City Engineer <br />Issued <br />Inspection By—/Z—X <br />Date Inspected 11 13 -7fV <br />NO. <br />k <br />