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ever�tt <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />NO. 20638 DATE P <br />Service Address <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Connection By <br />Address <br />Phone <br />DESCRIPTION: <br />Lot Block — <br />Division or Addition <br />Remarks: <br />SEE SKETCH ATTACHED <br />Utility Account No. <br />Connection Permit Fee <br />Connection Fee <br />Total Fee- <br />0 <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 Engmeer <br />Issued <br />Inspection Byy <br />Date Inspected — <br />NO. 20638 <br />