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(cvcrrlt <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />NO. 2072 DATE _ <br />Service Address <br />Billing Address <br />City, State, Zip_ _ <br />Owner (Mortgagor) -- <br />Billing Name <br />:onnection By <br />Address <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addition <br />Type Permit: <br />Remarks: <br />SEE SKETCH ATTACHED <br />Utility Account No.. <br />Connection Permit F <br />Connection Fee` <br />Total Fee <br />Signed <br />Customer <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Trunk _ <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />City Engineer ' <br />Issued By <br />Inspection By �� <br />Date Inspected � <br />NO. 20727 <br />