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everetl L) 1A - I? 7 i- <br />t -, I- ",p <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit I <br />N0. L 01, `} DATE _ L <br />Service Address_ _ Utility Account No. <br />Billing Address <br />City, State, Zip <br />ri <br />Owner (Mortgagor).—' <br />Billing Name <br />Connection Bv— <br />Address <br />DESCRIPTION: <br />Lot <br />Block._ <br />Division or Addition__ _ <br />TvnP nprmit- <br />SEE SKETCH ATTACHED <br />Connection Permit <br />Connection <br />Total Fee <br />Signed <br />Customer <br />Sewer District_ <br />Monthly Sewer <br />Monthly Sewer Constr. <br />Lateral <br />Abutting Lot Line <br />N, S, E, W, <br />Approved By_ <br />City Enpmeer <br />ssued By _ <br />nspection By—¢�CQ� <br />gate Inspected a 3 <br />NO. 20979 <br />