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everett <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />NO. 20793 DATE //i-- /`' <br />Service Address�� <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor).}�/�/V <br />Billing Name �7- 4C <br />Connection By <br />Phone <br />DESCRIPTION: <br />Lot <br />Utility Account No. <br />Connection Permit I <br />Connection Fee_ <br />Total Fee <br />Signed <br />Customer <br />Sewer District — <br />Block Monthly Soer S_... _. <br />Division or Addition_ Monthly Sewer Constr. <br />Type Permit: <br />Remarks: <br />a <br />v <br />CG d r <br />'7 <br />0 <br />SEE SKETCH ATTACHED <br />INSPECTION <br />Trunk— <br />Lateral — <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />City Engineer <br />Issued <br />Inspection 13 ' in. f/ '�L55o' <br />Date Inspected <br />i <br />No. 20793 <br />