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everett <br />� -���s <br />�_y <br />City of Everett <br />Engineering Department <br />� <br />_ J ��� � �:l' �� ,,,, <br />�� _ l r; � z ' <br />�, � � _, e <br />�; <br />Sewer Application and Permit <br />No. 20590 DATE <br />Service Address <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Connection By <br />,4ddress <br />Phone <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addition ' <br />Type Permit: <br />Utility Account No.. <br />Connection Permit F <br />Conneciion Fee_ <br />Total Fee <br />�� ISigned � � _ � <br />� Customer � �� - ' � <br />SEESKETCH ATTACHED <br />,., ���� � �_,� <br />Sewer District <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />Laterel <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />City Enginecr <br />I SSUCti <br />Inspection By � �"'�w"�"`�""' <br />Datelnspected��7 �� <br />No. 205�10 <br />