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evered <br />City of Everett <br />Engineering Departmem <br />Sewer Application and Permit <br />NO. 2 0 5 8 l DATE <br />Service Address Utility Account No. <br />Billing Address <br />City, State, Zip <br />Connection Permit <br />Connection <br />Owner (Mortgagor) Total <br />Billing Name <br />Connection By <br />Address— <br />Phone — <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addition <br />Type Permit: <br />SEE SKETCH ATTACHED <br />INSPECTION <br />Signed <br />Customer <br />Sewer District <br />Monthly Sewer Service, <br />Monthly Sewer Constr. <br />Trunk— <br />Lateral — <br />Abutting Lot Line <br />N, S, E, W_ <br />Approved By <br />City Engineer <br />Issued <br />Inspection By <br />Date Inspected L/ <br />NO. 20587 <br />