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a'uCi Pll <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />NO. I U i :� 11; DA? E <br />Service Address <br />Billing Address --- <br />City, State, Zip______ <br />Owner (Mortgagor) <br />Billing Name <br />Connection By fit <br />Address r 4 /h' <br />Phone_ <br />DESCRIPTION: <br />Lot_ <br />Block <br />Division or Addition _ l <br />Type Permit: <br />Utility Account No._ <br />Connection Permit Fee_ <br />Connection Fee <br />Total Fee <br />Signed <br />Sewer District <br />Monthly Sewer Service, <br />Monthly Sewer Constr. <br />Lateral <br />Abutting Lit Line <br />N, S, E, W_ <br />Approved By__ <br />City <br />Issued By <br />Inspection <br />Date InSDe <br />SEE SKETCH ATTACHED NO. 20739 <br />