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�verel <br />� <br />City of Everett <br />Sewer Ap�licflti <br />25749 <br />� <br />4 � � <br />S G% J <br />� a <br />on and P�Cr:�it <br />;..�� <br />- ��y <br />NO. DATE ✓ �.� %�� W, `I �s 7�' <br />�v� , <br />Service Address���� <br />Billing Address�{ � 1 �' � � � � � <br />CitY, Stete, ZiP-- n� r � t• �- i.^. ._,�l <br />Owner IMortgagor) -) i i.� 1�% l,'. �. �ir! S� �� <br />Billing Name �'� � � �"-1 <br />Connection By '� <br />rlddress -' �i r il�; i i: . !. L <br />_, �� <br />Phone ' �� 5 �� `/—�-- <br />DESCRIPTION: <br />Lot_ Block <br />Plat <br />Unplatted Desc� <br />Type Permit: . � ' ✓, a;' f % <br />Remarks: <br />IMPORTANT! <br />CALL 1�800-024-5555 48�HOURS <br />PRIOR TO DIGGING <br />CALL 259-8811 FOR �'JSPECTION <br />SEE SKEiCH ATTACH'�D <br />Ti� ._ ,- � <br />CHART <br />Sf,u� Tc cFiti.ff��c�s' <br />/D/�/�� <br />Utility Account No. <br />. (� <br />Permit <br />Connection Charge�s) <br />� ,. � ; <br />Total Fee ' � � ! <br />1, /; <br />, � <br />Signedc_ <br />Sewer 0 <br />Monthly Sewer Service <br />Monthly Sewer Conscr. <br />Lateral <br />Abutting Lot Line <br />N, S, E, W, <br />- , ,- - � <br />Approved By r' /_/-/'it- .1 ;� / �l /';iL <br />Ci�y Engineer <br />i I , / <br />Issued By �1�'4L.1�,[`i ri � l- ����, �:�L <br />7' <br />Inspection By -- <br />0 <br />Date Inspected �_�_,O� - <br />No. 2574� <br />li'!SFGC I IOiJ <br />