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evereri <br />e-30-a9 -5-7 -Ozlv--5p/ <br />City of Everett <br />Engineering Department <br />Sewer Application and Permi <br />NO. 20 i 42 DATE <br />Service Address <br />Billing Address__ <br />City, State, Zip_ — --- <br />Owner (Mortgagor) - <br />Billing Name <br />Connection By — <br />Address <br />Phone -- <br />DESCRIPTION! <br />Lot <br />Division or Addition <br />R -- <br />SEE SKETCH ATTACHED <br />iiiSPECTION <br />Utility Account No. <br />Connection Permit <br />Connection Fee_ <br />Total Fee <br />Signed__ Customer <br />Sewer District <br />— <br />IV tthly Sewer Service. <br />Monthly Sewer Constr. <br />Trunk <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved By City Egneer <br />Issued <br />Inspection By <br />DateInspected__-� <br />No. 20742 <br />