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i <br />evetett <br />e <br />City of Everett <br />Engineering Department <br />1� s �z317s" <br />1y� <br />Sewer Application and Permit <br />NO. 20666 <br />DATE <br />Service Address <br />Utility Account No, <br />Billing Address <br />Connection Permit I <br />City, State, Zip <br />Connection Fee_ <br />Owner (Mortgagor) <br />Total Fee <br />Billing Name <br />Connection By <br />Signed <br />Customer <br />DESCRIPTION: Sewer District <br />Lot <br />Block Monthly Sewer Service. <br />Division or Addition— '1/) ;''f, .0 % f <br />Monthly Sewer Constr. <br />Type Permit: <br />a <br />SEE SKETCH ATTACHED <br />INSPECTION <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />City Engineer <br />Issued <br />Inspection By tq-f <br />Date Inspected &A y' <br />NO. 20666 <br />u <br />