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City of Everett <br /> Engineering Department <br /> Sewer Application and Permit <br /> ., 3139 <br /> NO. 20594 DATE_ - - <br /> Service Address - -_— Utility Account No.- "'�' — 2 S- O / <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 _ Stgned <br /> Custortwi I <br /> Phone---- <br /> DESCRIPTION: <br /> hone --DESCRIPTION: Sewer District <br /> Lot - Monthly Sewer Service <br /> Block <br /> Division or Addition — _ Monthly Sewer Constr. <br /> Trunk <br /> Type Permit: <br /> Lateral <br /> Remarks: <br /> Abutting Lot Line <br /> N, S, E, W ft. <br /> Approved By <br /> City Engineet <br /> Issued By <br /> Inspection BY--L D <br /> y LIE <br /> Date Inspected <br /> 0 <br /> SEE SKETCH ATTACHED NO. 2. 0594 <br /> 4 <br /> I <br />