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everett 2 O � a�' <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />NO. 20613 DATE <br />Service Address z-J Utility Account No. <br />I <br />i <br />Billing Address -- <br />Connection Permit Fee <br />City, State, Zip ' + Connection Fee <br />Owner (Mortgagor) <br />Total Fee <br />Billing Na <br />Connection By <br />Signed <br />` Customer <br />Address .� <br />Phone <br />Sewer District <br />DESCRIPTION: <br />Lot ? 5 Monthly Sewer Service <br />r I <br />Block <br />Monthly Sewer Constr. <br />Division or Addition__—' <br />a <br />SEE SKETCH ATTACHED <br />INSPECTION <br />Lateral <br />*utting Lot Line <br />N, S, E, W. <br />Approved BY City Engineer <br />Issued <br />Inspection By �O <br />Date Inspected 6 3%7 <br />No. 20613 <br />