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eD <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />NO. 20162 / DATE — '' <br />Service Address ' L / /,,, ; ; I ,:,j <br />Billing Address.r- <br />State, <br />City. Zip_ <br />Owner (Mortgagor) <br />Billing Name <br />Connection <br />Address <br />r <br />Phone •.'c�/0 <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addition ' 1' <br />Remarks: <br />LIJ <br />SEE SKETCH ATTACHED <br />Utility Account No. <br />Connection Permit f <br />Connection Fee_ <br />Total Fee_ <br />Signed <br />customer <br />INSPECTION <br />Sewer D <br />Monthly Sewer Service <br />Monthly Sewer Constr, <br />Approved By <br />CnY Engineer <br />Issued By. <br />Connection <br />Inspection By K2 '( -- <br />Date Inspected G .� _3 <br />