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everetl <br />� <br />�ity of Everett <br />Se�wer �►p�►iicati�r� and Permit <br />NU. Z7O�i9 DATE Jenu�y�7��tte <br />Service Address_qg����,�. <br />Billi,og Address_,����,����_ <br />City, State, Zip_�,�� <br />Owner (Mortgagor�_,��at ilaaoc—ty <br />Billing Name__yi <br />Connection By <br />Address�� <br />Ph�,ne _, <br />DESCRIPTION: <br />Lot <br />F;at <br />Unplatted Descr <br />Type Permit: <br />Remarks: <br />Block <br />IMPORTANT! <br />CA L L 1-800-424�5555 48�HOU R S <br />PRIOR TO DIGGING <br />CALL 259-86�1 FOH INSPEC'i ION <br />SEE SKETCH ATiACHED <br />Utility Account No. <br />Permit Fee so_on <br />Connection Chargels) u.+.,., __ <br />Total Fee__3D.en <br />Y-���� <br />Signed 1'�----�_ <br />Customer <br />Sewer Dist <br />Monchly Sewer SerUic'e''i'U9 10�•� :,��, t_.�:,i i: '.� ,.� <br />Monthly Sewer Cons�i��=1''"�� <br />t::LIiG =10�I.1N� <br />Trunk [; °,:CF� i3.50 <br />. �+I, 3 �.W --- <br />L�teral !:tilkl�?1,3! 1 <br />1 'I: �l'_4.2.1i11 <br />Abutting Lot Line �'U00.^_iGtiB I <br />N S E W 5E6qSf? ,��. n;, ft. <br />��'�'.�"-� <br />Approved By_ �r,y���e n 17�,.�, <br />Ciry Engmeer <br />Issued By ci�� ��.��ypn <br />Inspec[ion By_���'��`�� <br />Date Inspected � �� �I <br />i;:: �'i=(;�i I( �i,� <br />No. 27048 <br />