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ever,tt <br />City of �verett <br />Engineering & Community Services <br />�ev�eer A,ppiic��ic��a ar�d P�rrnii� <br />�vo. 22260 DATE = � � �':ry <br />Service Addres� `/�r% f Jt+� -:f. �.- <br />Billing Address �-'�j• ---'� ,' i� � <br />Ciry, State, Z;p� � f i:tc • %^ =-� 2� <br />Owner (Mortgagorj - � ' <br />. <br />Billing Name - <br />Connection By - <br />Address <br />Phone � S :- (. `=�� �% _ <br />CHAftT <br />Utility Account No. .� - ��- J��' J <br />Permit Fee `v <br />i <br />. ^ <br />Connection Char-yeis)� ,_ 0 <br />-�.� `-�.i <br />Total Fee_1=___ <br />j' . <br />�/ i" � • `� �,� <br />9 � . �„�- '�� ` -- <br />Si r,ed fr-.____ <br />�� Customer <br />DESCRIPTION.: . Sewer District J � �� �� � � <br />� ^�'v�' <br />Lot -%1 ,' Blocf�� �, <br />Plat �'�'� ' : i � � �% Monthly Sewer Service_ - �� ___ <br />Unplatted Description Monthly Sewar Constr. <br />e <br />SEESKETCH ATTACHED <br />Trunk �' � ,-�� � <br />Lateral <br />Abutting Lot Line <br />N,S,E,IN. <br />_ ,,, • <br />Approvad 6y �' r - . <br />� CitY Engincer ��. -- <br />Y _ <br />Issued [3y ' ___ _ _ <br />Inspection B <br />Date I ns <br />N0. ���i'O <br />�„� ��. . INSPECTION �.r'...,.,�,�,� —. <br />