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% I <br /> City of Everett <br /> Engineering Department <br /> Sewer Application and Permit <br /> 33499 <br /> NO. 20629 DATE <br /> Service Address—* __ _ Utility Account No. <br /> Billing Address _ —_ Connection Permit Fee <br /> City, State, Zip__ __ Connection Fee <br /> Owner (Mortgagor) Total Fee <br /> Billing Name <br /> Connection By--------- <br /> Address--- <br /> y ----- <br /> Address —_ Signed cusmmer <br /> Phone — <br /> DESCRIPTION: Sewer District <br /> Lot <br /> Monthly Sewer Service <br /> Block <br /> Division or Addition- — —Monthly Sewer Constr. <br /> -- -- Trunk <br /> Type Permit: <br /> � Lateral <br /> Remarks: <br /> — -- Abutting Lot Linc <br /> N, S, E, W_ ft. <br /> -- Approved By <br /> (:,Iv Engineer <br /> Issued By <br /> Inspection By Civ <br /> Date Insptcted ,1s/7� <br /> SEE SKETCH ATTACHED NO. 20629 <br /> irr,iy ir, r <br /> v <br /> i <br />