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cvcrcli <br />City of Everett <br />Engineering Deparnnent <br />Sewer Application and Permit <br />NO. 20164 <br />X[it0 7 C/PATE <br />i ''G—iivii} <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 />Remarks: l ' <br />r <br />D <br />SEE SKETCH ATTACHED <br />Utility Account No. <br />Connection Permit Fee <br />Connection Fee <br />NoT 2�4, <br />Total Fee <br />Signed <br />Customer <br />Sewer District <br />Monthly Sewer Service_ <br />Monthly Sewer Constr.- <br />Approved By_ <br />City Engineer <br />Issued <br />Cornection By <br />Inspection By <br />Date Inspected <br />