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everett <br />� <br />City of Everett <br />Engineering Department <br />o s !`f e! <br />�/ 20-29 -S <br />c/•� !7% <br />J <br />Sewer Application and Permit <br />, , � - <br />NO. c . . � __ DATE <br />Service Address Utility Account No. <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor►_ <br />Billing iVame <br />Connection Permit Fee <br />Connection <br />Total Fee <br />Connection By 7" £� T Pac/l���r'' <br />Address /O�o� ��1i LL j�pS�gned <br />cu�tortrer <br />Phone f_;iE/'y%Ti y✓/y� H <br />�G,fin� <br />DESCRIPTION: Sewer District <br />Lot�Block� 1�,� Monthly Sewer Service <br />Division or Addition Monthly Sewer Constr. <br />SEE SKETCH ATTACHED <br />� :CTION <br />Tru <br />Lateral <br />Abutting Lot Line <br />N, S, E, W, <br />Approved By <br />City EnqineM <br />I ssu ed <br />Inspection By /��� � ��� <br />Date Inspected 3 // %% <br />NO• �167� <br />'::-a.�:,a <br />a <br />e <br />{`� :7�'�.''� <br />