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/ <br />• everett <br />� <br />� <br />City of Eve�ott <br />Engineering Department <br />�cv�ver Appiication and P�ermit <br />NO. DATE <br />Servi�:e Address <br />Billing Addres, <br />City, Statc, Zip <br />Owner (Mortgagor, <br />Biilirg Narr : <br />C��nnection By___ <br />Address <br />Phone —__- <br />DESCRIPTION: <br />I_ot _ <br />Block____ <br />Division or Addition <br />Tvre Permit: <br />Utility Account No. <br />� Connection Permit I <br />Connection Fee_ <br />Total Fee____ <br />, ,___ <br />,� .O v�.- % G-� .. <br />! - • � --- � �- . , <br />Si9ned--- �- -- - .. _---- - --- - ---- --- -------- <br />c�„�„�„�.� <br />9 <br />SEESKFTCH ATTACHED <br />Sewer District- _-- -- - -- ------ --- <br />Monthly Sewer Servir.e___ -- _ -- ---- --- <br />Monthly Sewer Constr. <br />Trunk_ --- -----.— - <br />Lateral <br />nbutting Lot Linc <br />N, S, E, W <br />Approved E3y — <br />Gty Enpmerr <br />ISSUBd BY <br />t. <br />Inspection BY .... � � � t`=.--- - - ----- <br />�1-� °% �G <br />Date Inspected----- - _-- <br />N �. <br />