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City of Everett <br />Engineering Department I <br />Sewer Application and Permit' <br />NO. <br />Service Address --- <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor)_ <br />Billing Name <br />Connection By_ _ . -- <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addition <br />Tvne Permit: <br />DATE <br />SovrN 3«0 �vr- <br />__ -- - Utility Account No <br />SEE SKETCH ATTACHED <br />iSPECTION <br />Connection Permit <br />Connection <br />Total Fee <br />Signed_ <br />Customer <br />Sewer <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Trunk <br />Lateral_ <br />Abutting Lot Line <br />N, S, E, W_ <br />Approved By_ <br />City Engineer <br />Issued <br />Inspection By. `t <br />Date Inspected 3 75 <br />No. 20962 <br />