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everQtt / ' <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />NO. 20 f.': i DATE -- -- <br />Service Address _ .. <br />_ _ _ _ Utility Account No. <br />Billing Address_ <br />_ . _ Connection Permit f <br />City, State, Zip_---___ <br />_ Connection Fee_ <br />Owner (Mortgagor) . <br />_ _ Total Fee <br />Billing Name _ <br />Connection By_ <br />Address ___ _ Signed <br />Cuflorner <br />Phone -- <br />DESCRIPTION: Sewer District <br />Lot <br />Block Monthly Sewer Service <br />Division or Addition -i Monthly Sewer Constr. <br />Type Permit: <br />Remarks: <br />SEE SKETCH ATTACHED <br />Lateral_ <br />Abutting) Lot Line <br />N, S, E, W. <br />Approved By <br />C,ty Engm m <br />Issued By <br />Inspection By <br />)ate Inspected_ T�////7`/ <br />NO. 20696 <br />