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everett <br />J <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />NO. 2 U DATE 7 <br />Service Address <br />Billing Address_ i1.a/rC. <br />City, State, Zips/j6--'%! <br />Owner (Mortgagor)_' _ //,/i <br />Billing Name t/1"� <br />Connection By_. <br />Address re, <br />Phone L t ' /f <br />DESCRIPTION: <br />Lot <br />Utility Account No. <br />CI <br />Connection Permit Fee <br />Connection Fee n C.. <br />Tr,.a. Fee ; r- o <br />Signed <br />crammer <br />Sewer District <br />Block_ Monthly Sewer Service <br />Division or AdditionyL��C��� Monthly Sewer Constr. <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />c-n• engine <br />ssued B <br />inspection By— R� 1 t/. <br />late I nspected_ I — ZZ — % <br />SEE SKETCH ATTACHED <br />