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�' <br /> CHART N0. <br /> eve�etl <br /> e ,,. <br /> : <br /> �ity of Evarett �, '� ; ' � ,' J <br /> b�'"�,�. <br /> Sewer Applicction and Permit �� 2 �,�(��o + <br /> � , . � � . , ., <br /> No. 26384 DA7E ��' �3� g�— <br /> Service Address �73� �AK�K —� �� Utility Account Nu. -- <br /> Billing Address Permit Fee <br /> City,State, Zip Connection Chargels) <br /> Owner (Mortguror) Total Fee <br /> Billing Name <br /> Connwction By�S.�e:Ly mT ��G �e <br /> Address. / Signed_� ���— <br /> / cw�om.. <br /> �IOIIB <br /> � DESCRIPTION: Sewer Oistrict_._—_ <br /> . <br /> Lot Block_ Monthly Se,ver Sei•+ice_ <br /> Plet <br /> Unplatted Description Monthly��er.•er Constr. <br /> — Trucic_ <br /> Type Permit: �Lo p����o <br /> Latarcl-- <br /> marks: �/���� �` /" <br /> Cu r' D u� .77.i '�J' Abutting lot Line <br /> N, S, E, W_ __ft. <br /> �s ' � Y' G " � � ��. <br /> Approved By <br /> cNr�nu�nn�r <br /> IMPORTANTI <br /> Issued By __— <br /> CALL 1�800J124-556548•HOURS <br /> PRIOR TO DIOGING <br /> CALL 269$811 FOR INSPECTION <br /> Inspection By � <br /> Date 1 nspected � � ' �" g� <br /> SEE 5KETCH ATTACHED No. 26384 <br /> �,, CUSTOMER COPY <br />