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lVtfltl <br />�e <br />City of Everett <br />Sewer Application and Permit <br />No.25532 DATE parch 20. 19M6 <br />S711 <br />Service Address SM pladaV ►lace <br />Billing Address 9210 EVaMWWY <br />City, State, Zip Everett WA 9R204 <br />Owner (Mortgagor) 0![eeaer 6 ORMW Ceestr. <br />Billing <br />Connection <br />Phone 3M7700 — <br />DESCRIPTION: <br />Lot-40Block t — <br />Plat 6eVerlr R1111 NV 4 <br />Unplatted Description <br />Type Permit: <br />Remarks: <br />IMPORTANTI <br />CALL 1800424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 2598811 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />CHART <br />SF,ur ry-'.vi➢i'TiNG <br />io/9/BE <br />Utility Account No <br />Permit <br />Connection Charge(s) 0a0 DO <br />Total Fee_ go <br />SpKlal Snwr Charges Ord. 1171-BS <br />ester 4,1I1).20 <br />Satwrl0 909.R0 <br />Si3;� <br />Signed <br />Sewer District weed I <br />Monthly Sewer <br />Monthly Sewer Constr. <br />Trunk 176 an <br />Lateral Mel en <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />Issued By_ S. (a'Yetae <br />Inspection B;': <br />Date Inspected %-70-,.6 No. 25532 <br />INSPECTION <br />