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— <br />e f` <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />NO. 20343 <br />DATE <br />Service Address �d _—__�. - Utility Account No. — <br />Billing Address_ "��` Connection Permit Fee <br />City, State, ZipConnection Fee_ <br />Owner (Mortgagor) `� / / _ Total Fee — <br />Billing Name_ <r- <br />Connection By �' «' ' `� •' �� <br />AddressC'`"' I Y�G!%" * » Signed_ <br />, Customer <br />Phone " hrJ L cs/Ir� <br />DESCRIPTION: <br />Lot <br />Block �T_ <br />Division or Addition_ <br />Sewer Distr <br />Remarks: <br />Its O //-7—/ - 7 <br />SEE SKETCH ATTACHED <br />INS(''C�'.lb7G: <br />Monthly Sewer <br />Monthly Sewer Constr <br />Approved <br />Issued By <br />Connection By <br />Inspection By <br />Date Inspected <br />City Engineer <br />