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ev�re�t <br />� <br />City of Everett <br />- _ � -. L �_ _ -,; <br />� � � � � �� �, <br />� _�p -i- <br />Engineering Department ` �� <br />Sev�r�r Appli�catiorr and p�ra�et <br />rvo. 2 0 � � :� <br />DATE <br />Se!vice Address <br />Billing Address <br />City, State, Zip _ <br />Owner �Mortgagor) � <br />Billing Name <br />Connection By <br />Address <br />Phone <br />DGSCRIPTION: <br />Lot <br />Block <br />Division or Addition <br />Utility Account No.=; <br />Connection Permit Fee_ <br />Connection Fee <br />Total Fee <br />�- �� ; <br />_.i - <br />Signed <br />Cus:omer <br />SEESKETCH ATTACHED <br />IPlSPECTIOi; <br />Sewer District <br />Monthly Se�-oer Service <br />Monthly Sewer Constr. <br />Trunk <br />Lateral <br />Abutting Lot Line <br />N, S, E, W. <br />Approved By -_ <br />Ciry Engmeer <br />Issued <br />Inspection By � � <br />1 - <br />� <br />�atelnspected � - � . <br />NO. �rinn- <br />�_ � �' , _ <br />