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everen <br />e <br />City of Everett <br />Sewer �4pplication and Permit <br />NO. G���`� DATE a,.�� tt Ig,� 1,9gg _ <br />Service Address Utility Account <br />Billing Address <br />City, State, Zip ����_y��_ <br />Owner (Mortgagor) ,� ___.__ <br />Billing Name <br />Connection By <br />Address <br />Phone <br />DESCRIPTION: <br />CHART <br />5,,.--i.;'� �1��,-�;"�; '��-. -vs <br />Permit Fee _ <br />Connection Charge� <br />Total Fee . <br />Speaial Vtllily P�e pcd. 1171-85 <br />�ratar 224.00 � <br />i <br />; <br />--- ---"=�� /:;' . <br />Signed i .--- - - - _��- <br />Customer <br />Sewer District <br />Lot �,q Block <br />Plat Monthly Sewer Service. <br />Unplatted Description_ Monthly Sewer Constr. <br />Type Permit: <br />Remarks: <br />IMPORTANT! <br />C.ALL 1-800-024-5555 48•HOURS <br />PRIOR TO DIGGING <br />CALL 259�8811 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Trunk <br />4; �� iu•, lR. .... :t <br />Lateral •� <br />Abutting Lot Line�LC�i �Y657,0(! <br />!'lltG 260.D!) <br />N� S• E� W+Nc4:'�-4oy.5� ft. <br />PLII CH �26.00 <br />l3 �H b3.�ip <br />L :X'CH '�t5,Ck1 <br />UkU1rV 42U.U) <br />Approved By �: . <br />- n fler;.�.C� <br />llii J jG�'t•� <br />Issued By � - <br />t�k 1[G i60.IN1 <br />CPk.I:i; itl:�i.(iU <br />Inspection By ��'�"-�"� <br />Date lnspected % ��`�'�"�G <br />li�i:;i'LC'j�ir,i i <br />No. 26635 <br />