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. <br />everett <br />� �j t�� <br />City of Evereti �_--��. <br />Engineering Uepartment <br />c►ErwPr Application and Permit <br />"o. 21014 <br />Service Address <br />Billirg Address <br />City, Stat�a, Zip <br />Owner (Mortgagor�_ <br />Billing Narre <br />Connection By <br />Phone. <br />C�ESCRIPTION: <br />Lot <br />Block <br />Division or Add <br />DATE <br />Utility Account No., <br />Connection Permit F <br />Connection Fee__ <br />Total Fee <br />Signed <br />cu:tomer <br />SEESK.ETCH ATTACHED <br />Sewer Districi <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Trunk__ <br />Lateral <br />Abutting Lot Line <br />N, S, E, W_ <br />Approved <br />I SSU ed <br />Inspection <br />Dateln;oe <br />Ci1y Engineer <br />rvo. ^ 1 Q 1 LI <br />