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everett <br />e 54��A7- <br />City of Everett <br />Engineering Department <br />�"D '�4le- <br />Sewer Application and Permit <br />No. 20890 DATE <br />Service Address_ <br />Billing <br />City, State, Zip <br />Owner (Mortgagor) ' <br />Miling Name <br />Connection By <br />Address - it % ��:rt'( i/ i y <br />Phone— 4-1 <br />DESCRIPTION: <br />Lot <br />Utility Account No. <br />Connection Permit I <br />Connection Fee_. <br />Total Fee <br />Signed <br />Custorner <br />Sewer District_`�— <br />Block <br />Monthly Sewer Service <br />Division or Addition_Monthly Sewer Constr, <br />SEE SKETCH ATTACHED <br />t <br />Latera <br />Abutting Lot Line <br />N, S, E, W <br />Approved By_• <br />City Engineer <br />Issued <br />Inspection By <br />)ate Inspected <br />NO. 20890 <br />