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City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />NO. 20670 DATE <br />Service Address Utility AccountN0. 'G - [ f3[•'G / <br />B'II' Add <br />Mill; <br />ress <br />City, State, Zip %% %//r / /4/' <br />Owner (Mortgagor) -V -7'n <br />Billicg Name <br />Connection <br />7r <br />l l <br />Phone _ <br />r . <br />DESCRIPTION: <br />Lot <br />Connection Permit <br />Connection Fee / • %7 `7, ill Z / <br />Total Fee <br />i <br />Signed <br />Customer <br />i <br /><I <br />Sewer District <br />Block Monthly Sewer Service. <br />Division or Addition Monthly Sewer Constr. <br />SEE SKETCH ATTACHED <br />INSPECI ION <br />Lateral <br />Abutting Lot Line <br />N, S, E, W 2. %% ft. <br />Approved By <br />City Engineer <br />Issued <br />Inspection By 4 <br />Date Inspected <br />VN0-22 0 6 7 <br />