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t' <br />CVCfCii � � <br />Q�5 <br />City of Everett VV <br />Engineering Department <br />Sewer Application and Permit <br />NO. 2069 3 DATE <br />33623 <br />Service Address 'J r`(' Utility Account No. <br />Billing Address W. Conr.nJnr� "�Ntttnection Permit Fee <br />City, State, Zip -I- lConnection Fee <br />/ Co. <br />ENEOwner (Mortgagor) -- -- 1t" NE Total Fee— _ <br />Billing Name <br />Connection By____Ga Icn, ° &1'1�lk_ <br />Address 7 Signed <br />Customer <br />Phone_ <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addition <br />Remarks: <br />SEE SKETCH ATTACHED <br />Sewer District <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />Trunk _ <br />Lateral <br />Abutting Lot Line <br />N, S, E, W_ ft. <br />Approved By <br />May Engineer <br />Issued <br />Inspection By <br />Date f nspected ':�o /7 `i <br />// ' NO. 20693 <br />