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evcrsti <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />NO. 20636 DATE <br />Service Address <br />Billing Address_.__ <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Connection By . <br />Addresses <br />Phone <br />DESCRIPTION: <br />Lot._ <br />Block_____ <br />Division or Addition_ <br />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 />Lateral <br />Abutting Lot Line <br />N, S, E, W, <br />Approved By <br />C��V Enpmeer �— <br />Issued 8 <br />Inspection By tY 1-2 <br />Date Inspected_ 5-/Y1jo/ <br />NO. 206'F <br />