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everett <br />e <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />NO. 1020 " <br />DATE y <br />Service Address--- /' ___ , Y <br />Billing Address l <br />City, State, Zip <br />Owner (Mortgagor) <br />Utility Account No. <br />Connection Permit Fee <br />�2G92 <br />Connection Fee_ 1� <br />-Total Fee�0,_ _. �� - <br />Billing Name <br />Connection By <br />Address Signed <br />Curtomer i <br />rnone_ <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addition - <br />SEE SKETCH ATTACHED <br />INSPECTION <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr <br />Approved By <br />CIrY Enpinex <br />Issued By <br />Connection <br />Inspection <br />)ate Inspected <br />