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everett <br />e <br />City of Everett <br />Sewer Application <br />NO. 26225 DATE <br />CHART NO. <br />Y8 <br />{ <br />p pp pp p <br />CD 41 <br />oo <br />CA <br />and Permit, <br />_ <br />.. <br />Service Address 5702 saac <br />Billing Address 12A21 1!I Amm- <br />City, State, Zip --''• "' °a'� <br />Owner (Mortgagor) ^ L <br />Billing Name <br />Connection 8y <br />Address ■mm <br />Phone +,17 "" — <br />DESCRIPTION: <br />Lot 1 Block <br />Plat 01 104 <br />Unplatted Description <br />Utility Account Nc. <br />Permit Fee to ^^ <br />Connection Charge(s)_ <br />Total Fee -- <br />opm -W y !�.� Ii7�I=iFs <br />WatAr <br />ei�` ,1 :! I <br />650.00 <br />Signed customer <br />Type Permit: tlw connection _— <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 />Sewer District <br />Monthly Sewer <br />Monthly Sewer Constr. <br />Trunk <br />Lateral see 00 <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />issued By g++!�' —s-- <br />Inspection By <br />Date Inspected R - L <br />INSPECTION <br />No. 26225 <br />ft. <br />