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ri <br />eV -- u' <br />City of Everett <br />Engineering Be scut <br />Sewer Application and Permit <br />NO. 20974 DATI <br />Service Address _ <br />Billing Address z45V"et _ <br />City, State, Zips c ;c <br />I Owner (Mortgagor) <br />Billing Name �IiLJE= <br />Connection By 1I Alze' _ <br />Phune <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addition.' <br />Type Permit: <br />nemari(s: <br />SEE SKETCH ATTACHED <br />Utility Account NO.: <br />Connection Permit Fee <br />Connection Fee_ 7�' <br />Total Fee <br />Signed__ <br />Customer <br />.newt:! LAW <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Trunk <br />Lateral_ _ <br />Abutting Lot Line <br />N, S, E, W_ <br />Approved By__, /'1"it'; ;,'C <br />City Engineer <br />r / '/ni <br />Issued By_ <br />J� <br />Inspection By ` t , sz t-ate <br />JDate Inspected_-G — Z 3 — 7.S <br />NO. 20974 <br />