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everrtt p <br />City of Everett <br />Engineering Department f �_ <br />Sewer Application and Permit <br />NO. 20 G 3 7 DATE <br />Service Address P / <br />Billing Address ___ <br />City, State, Zip __.. <br />Owner (Mortgagor <br />Billing Name <br />Connection By <br />Phone <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addition <br />Tvnw Permit - <br />Remarks: <br />0 <br />SEE SKETCH ATTACHED <br />Utility Account No. <br />Connection Permit <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 />City Engineer <br />Issued <br />Inspection By /J! ) <br />rate Inspected �/ 7 <br />NO. 20637 <br />