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everett <br />e <br />City of Everett <br />Sewer Application and Permit <br />NO. 26204 DATE Wmy_14, 1fd87 - <br />Service Address 76n� Aawr�r HL <br />Billing Address H-A <br />City, State, Zip 902on <br />Owner (Mortgagor) t Collins <br />Billing Name Cam <br />Connection -- <br />Address <br />Phone <br />Utility Account No. <br />Permit Fee_�5 <br />Connection Charge( <br />Total Fee . 5 <br />Signed ~ <br />customer <br />DESCRIPTION: Sewer District <br />Lot 1 Block 8 — <br />Monthly Sewer Service. <br />Plat park-- <br />Unplatted Description Monthly Sewet Corstr. <br />Tun- Permit <br />Remarks: <br />IMPORTANTI <br />CALL 1-800-424.5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8811 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Abutting Lot Line <br />N, S, E, W <br />Approved By� <br />U1/ii/ ear- 4AtI (CilRNS":h9 04t <br />i <br />Issued By <br />R Sk1 H 51,50 <br />IN700 &% <br />SE14Y 4250 <br />CASH t4.00 <br />Inspection By <br />Date Inspected <br />No. 26204 <br />INSPECTION <br />