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�--- ;_-. <br />everett <br />� <br />City of i:verett <br />Engineering �epartment <br />,, , � <br />,,. <br />, i. <br />Sewer A��lication and PerrrAi# <br />N0. DATE <br />Service Address / � � � 5� �� ` "��"^""� � <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Connection By <br />Address <br />Ph ne <br />DESCRIPTION: <br />Lot�— <br />Block <br />Division or Addition <br />-/ _ � �% —� : f� - 5 <br />Utility Account Na. _ <br />Connection Permit Fee_ <br />Connection Fee_ y�s �f ✓'�� � �' � <br />Total Fee <br />$Ig�ed " Cuscomer <br />Sewer District_.__ <br />Monthly Se�ver Service. <br />_ Monthly Sewer Constr. <br />— Trunk <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />City Engineer <br />Issued <br />,,� �c`� <br />Inspection By �D,�� �" ''`"� � _-� <br />Date I nspe:ted �f> �,Z�— <br />I <br />NO. �_'` ,`. <br />� <br />