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1* <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />No. 20993 DATE <br />Service Address <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name__ <br />Connection By <br />Phone <br />DESCRIPTION: <br />Lot <br />Block — <br />Division or Addition <br />Type Perriit: <br />Remarks: <br />SEE SKETCH ATTACHED <br />Utility Account No.. <br />Connection Permit F <br />Connection F <br />Total Fee— <br />Signed — <br />Customer <br />Sewer District__ <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Trunk <br />Abutting Lot Line <br />N, S, E, W <br />Approved By_ <br />City Engineer <br />Issued B <br />Inspection By�—� <br />Date I nspected_(/ — Z 7— % 5 <br />No. 2C9943 <br />