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, <br />evere�A ;�/ - 30 - Z I - `� �°�'�^ <br />� <br />City of Everett <br />Engineering Department <br />� <br />,� �'� j 75 <br />, <br />Sewer Application and Permit <br />No. 20732 DA?E � -" <br />Service Address <br />Billing Address —� <br />City, State, Zip � ' ' � <br />Owner (Mortgagor) <br />Billing Name <br />Connection By � <br />Address <br />Phone <br />DESCRIPTION: <br />Lot <br />Block__. <br />Division or Addition <br />Type Permit: <br />Remarks: <br />Utility Account No. <br />Connection Permit I <br />Connection Fee_ <br />Total Fee <br />Signed_ <br />Cus�omer <br />SEE SKETCH ATTACHED <br />Sewer District <br />Mon?hly Sewer Service. <br />Monthly Sewer Constr. <br />Abutting Lot Line <br />N, S, E, W, <br />Approved By <br />Ciry Enginecr <br />I ssu ed <br />Inspection By �U/' <br />Dste I nspected ��/ z� 7 y <br />N0. �,�-„�n <br />�, <br />