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evereh <br />� ��� ' " � �_ _ . <br />� <br />' � �./n � <br />I'� <br />City of Everett . _— <br />Engineering Departmen[ <br />Sewer Application and Permit <br />No. 20G76 <br />DATE <br />Service Address <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Bitling Name - __— <br />Connec;ion By_ <br />Add�ess ' – _ <br />DESCRIPTIfjN: <br />Lot <br />Block_ <br />Division oi Addition <br />litility Account No._ <br />Connection Permit Fee <br />Connection Fee__. <br />Total Fee ' <br />Signed <br />� ' Custamer � <br />SEESKETCH ATTACHED <br />Sewer District___ <br />�llonthly SewerSe�vi�e. <br />Monthly Sewer Constr. <br />Abuttiny Lot Line <br />N, S, E, V�'. <br />Approved <br />I ssued <br />Engincer <br />Inspection By �%''�� <br />Date Inspected � �Q � <br />NO. ^(�I� ((; <br />