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everett <br />�e <br />City of Everett O <br />Sewer Application and Permit <br />� NO. <br />27000 DATE 5- t I - 84 <br />! <br />I <br />„j Service Address - 14 3 4 re i'ie-YA I he- Utility Account <br />Billing Address <br />City, State, <br />Owner (Mortgagor) <br />Billing Name Connection By� OF rr ! Y _-t f <br />DESCRIPTION: <br />Lot <br />Plat — <br />Block <br />Permit <br />Connection Charge(s) <br />Total F <br />Signed <br />Customer <br />Sewer <br />Monthly Sewer Service — <br />Unplatted Description Monthly Sewer Constr. <br />Tvimt Permit- Q d ^ e <br />Remarks: <br />72 <br />In%401 <br />S� PL cz') ' <br />IMPORTANT! <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 />City Engineer <br />Issued Bye ,r) /V (M i i le r' <br />Inspection By <br />Date Inspected S/S-ZS 9 <br />No. 27000 <br />CUSTOMER COPY <br />