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everett <br />� <br />City of Everett <br />Fngineering 6epartment <br />�_'% - � � '� � <br />� �; <br />l.� -� L - � _ <br />,, ,� 'j.,' <br />Gy �,�J�, ,,,-1 <br />, . ,�� <br />Sew�r Application c�nd Permit <br />No. 20695 DATE ' � <br />Service Address�� ` —� Utility Account No. <br />Billing Addrdss ' ' -� Connection Permit I <br />City, State, Zip Conneciion Fee_ <br />Owner (Mortgagor) Tctal Pee <br />Billing Name <br />Connection By <br />Address_ �� Signed c�:�om�� <br />DESCRIPT�ON: <br />Lot � <br />Block <br />Division or Addition — <br />Sewer District <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />SEESKETCH ATTACHED <br />rr._ . _.. __ . <br />:u::. . <br />Lateral_ <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />City En9ineer <br />Issued <br />Inspection By '� � <br />Date I nspected_ � % �7 � <br />r <br />N0. "! �' , �i � <br />