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I <br /> � <br /> � <br /> CHART NO. ! <br /> everett <S�`-'1— �`� ��C(�tiC,� <br /> e � ��� <br /> City of Everett <br /> Sewer Application and Permit <br /> N0. Z 1 OO9 DATE �c..b.r it�i9an <br /> Service Address Utility Account No. <br /> Billing Address . Permit Fee . <br /> City, State, Zip Connection Charge�s) <br /> . <br /> Owner (Mortgagor) Total Fee <br /> IItilitp Omlopwnt !�� Ord. 1171-05 <br /> Billing Name r�t� l�g,pp <br /> Connection By <br /> Address Signed - ' <br /> cu:tomer <br /> Phone 1�/�1/EB ;.:nCd'tS UI.KkaN.'�8M13 i 1C: <br /> DESCRIPTION: Sewer District��� <br /> Lot y7 Block Monthly Sewer ServF�`�C h�5.00 <br /> Plat M• a ' <br /> Unplatted Description Monthly Sewer Con���,. '�'� <br /> il-� 6179.1�? <br /> Trunk '��47 <br /> Type Permit: � ' <br /> Laterel ��21'12 <br /> :w, . <br /> Remarks: F�-�''�` °�•� <br /> Abutting Lot Line��H a�,�.� <br /> N• S� E, W� ��� �'-�iE� ft. <br /> [ �'CN :15.UU <br /> DRlAdS' x�J.00 <br /> f:11ECK SS50.b(i <br /> Approved By 1►L-*�`+ R- 'istanr. <br /> City Enpincer <br /> IMPORTANT! <br /> Issued By tL�y�gn� <br /> CALL 1-800-024-5555 48•HOURS <br /> PRIOR TO DIGGING <br /> CALL 259AB11•FOR INSPECTION <br /> �� <br /> Inspection By ��— <br /> Date lnspected �' 3�� <br /> SEE SKETCH ATTACHED Np, �Z7OO� <br /> INSF�CTION <br /> � <br />