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everen <br />e <br />City of Everett <br />Sewer Application and Permit <br />NQ. Z7O64 DATE .�.�..�.. <br />sp 6, S9B9 <br />Service Address Utility Account <br />Billing Address <br />Ci:y, State, Zip <br />Owner (PAortgagor) <br />Billing Name <br />Connection <br />Address <br />i�10�18 <br />�1 <br />DESCRIPTION: <br />CHART N0. <br />5�,,.� � c[j�tC:,y S- Z2'8 % <br />�, <br />Permit Fee �p p0 <br />Connection Chargels) �q�� <br />Total Pee 30 00 <br />Otllitp D�wiopypt lh� p=d. 1171-SS <br />wtar 172,{3 <br />wrts' �54.57 <br />/ 627.00 f '� , <br />Signed �-���� i , � � � _ i - r� <br />' ustomer <br />Sewer District �� <br />Lot � Block <br />Plat �� lot 1Y D�slr HLi� �+� 3 Monthly Sewer Service <br />Unplatted Description _ Monthly Sewer Con�13/Ei9 11:.'_7Aif �QRit4391 tI►•'t <br />/ <br />Trunk ���� <br />Type Permit: � ��t� �4q.�C0 e7�.� <br />Lateral ���OB��.� <br />Remarks: N00006143 <br />Abutting Lot Line}K11ER. S?�.t.10 <br />N, S, E, Wi10�721�1inn ft. <br />6Y.[X3 31i21.50 <br />f'1.F�i fA0.00 <br />tiECJi 45i.U0 <br />PLM CH l9U.G? <br />Approved By ���� <br />IMPORTANT! �*�' q�•UO <br />CALL 1-BOOd24555548-HOURS � Issued By ��C��Y�.�7 <br />PRIOR TO DIGGING <br />CALL 259�FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Inspection By �%G bF��tAH <br />Date Inspected s��l--�i <br />INSPCCTION <br />No. 27064 <br />