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everett <br />� <br />City of Everett <br />Sewer Application and Pern'it <br />r,o. 26�!1i� DATE �sZ,-�i- �� <br />Service Address ? 8� 3 Lc�. h�A r�l /lUG" <br />Billing .4ddress <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name_ <br />Connection By r_...� �'�� O r %i�P ��"�f" <br />Address <br />Phone <br />DESCRIPTION: <br />Lot <br />Plat <br />Block <br />CHART N0. �': ��! -" '-� <br />�O� I�:�rEL i�loT�iMf�15 <br />•-F.)rR�( <br />Utility Account No. <br />F'ermit Fee <br />Connection Charge� <br />Total Fee <br />Signed <br />Sewer District_ <br />Monthly Sewer <br />Unplatted Description Monthly Sewer Constr. <br />Ty��� Permit: <br />Remarks: <br />,. <br />�nnx-c:��u,-� (� �ZS � "J ° f �+E� <br />�3c, p��, IMPORT�NT! <br />CALL 7-600-024-5555 48•HOURS <br />PRIOR TO DIGGING <br />CA:L259�8811 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Trunk <br />Latera <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />Ciry Engineer <br />Issued By ��t� N Mi l�� 1- <br />Inspection By ' <br />Date ! nspected /� - ��% - g� <br />r�i��C'�'_::f�rC �, <br />N0. � I; li 1 ' , <br />