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L <br />tt <br />�I <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />NO. 2 0 4 2 DATE <br />Service Address_ <br />Billing :address <br />City, State, Zip' <br />Owner (Mortgagor)_ (.'-%)x"+' <br />Billing Name <br />Connection By. ' AJl 4// <br />DESCRIPTION: <br />Lot — <br />Utility Account Ni <br />Connection Permit <br />Connection Fee— <br />. l'otal Fee___ <br />Signaj <br />Customer <br />Sewer District <br />Block_.__ Monthly Sewer Service <br />- <br />Division Division or Additionf/ V/)d i7" Ii1 H <br />--- Monthly Sewer Constr. <br />TvDe Permit- <br />SEE SKETCH ATTACHED <br />! <br />,. <br />Trun <br />Lateral <br />Abutting Lot Line <br />N, S, E, W, <br />4pproved By <br />city Enainea <br />ssued B <br />,�. <br />t.pection By <br />ate Inspected <br />NO. 20842 <br />