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CHART NO. <br /> evei�tt <br /> � �r'rJT T� [f/A/'r�..J> >�3i�R8 <br /> City of Everett <br /> Sewer Application and Permit <br /> N0. Lv452 DATE _ <br /> . <br /> Service Address Utility Account No.� <br /> Billing Address�. . Permit Fee . <br /> City,State, Zip Connection Charge�s) <br /> . . <br /> Owner (Mortgagor) Total Fee <br /> Billing Name Sp�cl�l Otllity P�e Ord. 1171-85 <br /> Connection By Ser�r do0.00 <br /> Address Signed __+ <br /> Cuslomer <br /> Phone <br /> DESCRIPTION: Sewer District ' - <br /> Lot Block <br /> Plat Monthly Sewer Service _ <br /> Unpletted Description Monthly Sewer Constr. <br /> Typa Permit: Trunk 110.00 <br /> Lataral <br /> Remarks: <br /> Abutting Lot Line <br /> N, S, E, W ft. <br /> tI�JN/67 1�:':`[fYt lXli)AHBL19l tt1:t <br /> — -- Appraved By��_��_ <br /> r <br /> IMPORTANTI ���� *�•a� <br /> Issued By ffN�� e1 ��i <br /> CALL7AOD�424-6G5548•HOURS i171�J 240U.1k1 <br /> PR�OR TO DIG(iING G�:;U; i54U.W <br /> CAL1.259$811FORINSPECTION <br /> �nspection By � <br /> __ Datelnspected ���7 <br /> SEE SKETCH ATTACHED N0. 26452 <br /> I���PECTIGN <br />