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everetl <br />� <br />City of Everett <br />S�wer Application and Permit <br />N0. �v91� DATE <br />Service Address a025 Hoyt Ave. <br />Billing Address_ 11525 19th nve, SE <br />City, �tate, Zip �'°�ett, WA 98205 <br />Owner (Mortgagor) w��r Deve2ogment <br />Billing Name �t° <br />Connection 8y s� <br />Address_ $8� <br />337-1OG6 <br />DESCRI?TION: <br />Lot Blor,k <br />Ptat <br />lJnplatted Description_ <br />Type Permit: <br />Remarks: <br />off <br />N <br />IMPORTANT! <br />CALL 1-800-024-555548-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8811 FOR INSPECTfON <br />SEE SKETCH qTTACHED <br />Y <br />Utility Account No. <br />Permit Fee Z SA <br />Connection Charge(s) <br />Total Fee .. �.. <br />Signed <br />Customer <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Latera <br />Abutting Lot Line�}�`5�`�' y°`F��t� n���}H'i`�� _�' f <br />N, S, E, W.,,,. '. ft. <br />,..�k� , <br />L' .`J'l;H m i. `.iD <br />1-�0+�2641:: <br />:fl;F:li 8:'.SU <br />LIiCCI; t ;.(k'1 <br />Approved By_ At3+fiEn R. TfiEAI, <br />Ciry Engineer <br />Issued Ly Susy bau cn <br />Inspection <br />Datelnspe <br />Ci�; i:C�i IG��! <br />N0. 26912 <br />