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i <br />evrritt' 2�_ 5 <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />NO. 20958 DATE <br />Service Address 42 390 <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 />rype Permit: <br />SEE SKETCH ATTACHED <br />Utility Account No. <br />Connection Permit I <br />Connection Fee_ <br />Total Fee__ <br />Signed <br />Sewer District <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />Trunk <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved By_ <br />City Engineer <br />Issued <br />Inspection By "" r <br />Date Inspected_ <br />NO. 20958 <br />