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everPtt <br />� <br />City of Everett <br />Engineering Oepartment <br />-. / � y <br />� V" r �� <br />� , �-,_2�,� % <br />� !: ; ; ; ✓ <br />/�' <br />Sewer Application and Permit <br />No. 2 0 G 19 DATE <br />Service <br />Billing Address <br />Utility Account No <br />Connection Permit <br />City, State, Zip Connection Fee <br />Owner �Mortgagor) Total Fee � <br />Billing Name <br />Connection <br />/� � � <br />Signed ,'�% ��/v�'��/2/S�S <br />� Customer <br />DESCRIPTION: Sewer District <br />Lot <br />Biock Monthly Sewer Service, <br />Division or Addition Monthly Sewer Constr. <br />Tvne Permit: <br />SEESKETCH ATTACHED <br />C� �— ` , <br />� <br />Trunk <br />Lateral <br />Abuttiny Lot Line <br />N, S, E, W <br />Approved By <br />Ciry Enginecr <br />Issued By <br />Inspection By�n/ H" <br />Date l nspected y d�� �1 <br />NO. ^���i�l <br />