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everett <br />�e <br />City of Everett <br />Sewer Application and Permit <br />N0. 25490 DATE ' <br />Service Address k 1 7 � <br />Billing Address--SAM t—• --- — <br />City, State, Zip_ <br />'I <br />Owner (Mortgagor) <br />Billing Name <br />Connection By <br />Address �� L✓Z�/�� <br />Phone � ' 836 S <br />DESCRIPTION <br />Lot Block <br />Plat <br />Unplatted Description <br />Type Permit: <br />Remarks: ` t ,yn\n pfDQ etJ� <br />IMPORTANT! <br />CALL 1.800-424.555548•HOURS <br />PRIOR TO DIGGING <br />CALL 259-8811 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />CHART <br />ttility Account No. <br />Permit Fee (, <br />Connection Charge(s) <br />Total Fee /eo <br />�xo /1l <br />Signed %� ' <br />customer <br />Sewer District <br />Monthly Sewer Service, <br />Monthly Sewei ;nstr. <br />Trunk <br />Lateral <br />Abutting Lot Line <br />N, S, E, W_ <br />i <br />Approved By - <br />city Engineer <br />Issued By '-- <br />i <br />Inspection By <br />Date Inspected <br />N� 25490 <br />INSPECTION <br />