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1 �t'� G` p ,i � �}s �� ➢ � �is5tr�.X�V <br />-tY1MIK-, F <br />evereft <br />,.e <br />City of Everett <br />Sewer Application and Permit <br />No, 263?-7 DATE =se <br />ptember <br />Service Address_ dn5 55 -nett hall iq-=— <br />Billing Address_ come <br />City, State, Zip_ <br />Owner (Mortgagor) <br />Billing Name C.- <br />Connection Go <br />Address n n Box 1067 2..11pvaft m»nn <br />Phone <br />DESCRIPTION: <br />Lot Block <br />Plat <br />Unplatted Description <br />Type Permit: now Connection <br />Remarks: <br />IMPORTANT! <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 25MB11 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Utility Account N <br />Permit Fee 30.00 <br />Connection Charge(s) <br />Total Fee <br />"cial U12M Utility Yee Ord. 1171-85 <br />water 221IMXYi 1982.75 <br />sever 5227.25 <br />7210.00 <br />Signed <br />Customer <br />Sewer District <br />Monthly Sewer <br />Monthly Sewer Constr. <br />Trunk <br />Lateral 1538.84 <br />Abutting Lot Line <br />N,S,EW ft <br />09/IS/W7 11WAH 0"07189 113 <br />iiti�Jui6�+17. <br />Approved By 5—. -- <br />i, <br />E SF,f { 41S.00 <br />Issued By�i*WV - <br />WILP 14U.I!U <br />1Jq+IlOc ;S0.G0 <br />FdH t "'"•' � <br />Inspection By <br />C ..64 <br />Date Inspected <br />No. 26337 <br />INSPECTION <br />