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eia <br />City of Everett <br />Sewer Application and Permit <br />26002 <br />NO. DATE �acambrtr Z:2,--19R6-� <br />Service Address 4117 Pnvt Aire <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor)_ Rm_ P_ nrursr <br />Billing Name <br />Connection By Pnl l�r a Cn, <br />r , <br />Phone <br />DESCRIPTION <br />Lot 9 rr 10 Block _}F <br />Plat <br />L7-t8-T`aF:Ynt <br />Unplatted Description <br />Type Permit: ca.p - o <br />Remarks: <br />IMPORTANTI <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 25"811 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />CHART" <br />SENT ra tlr.4.en�vb- <br />Utility Account No. <br />Permit Fee <br />Connection Charges) <br />Total Fee <br />Signed <br />Customer <br />Sewer D <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Tru <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />City ngineer <br />Issued By MArgAmf P_ Mni nr1 <br />Inspecti�8 <br />Tate Inspected% _ <br />No. 26002 <br />INSPECTION <br />7 <br />