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We <br />City of Evetett <br />Sewer Application and Permit <br />No. 25454 DATE <br />2804 Grand <br />Service Address <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Connection By_ City of Everett <br />2/11/86 <br />CHART NO. I rl� - I -� <br />�n <br />C) <br />o <br />n <br />c <br />Utility Account No. - <br />Permit Fee None <br />Connection Charge(s) <br />None <br />Total Fee <br />Don Miller <br />Signed <br />Customer <br />DESCRIPTION: Sewer District <br />Lot Block — Monthly Sewe• Service <br />Plat <br />Unplatted Description Monti. , -ewer Constr. <br />Tvoe Permit: Ranair <br />Remarks: <br />S7"v <br />IMPORTANTI <br />CALL 1.800424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259.8811 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Abutting Lot Line <br />N,S,E,IN <br />A. R. Theal <br />Approved By_ <br />City Engineer <br />E. Bond <br />Issued By -- <br />Inspection By �'� <br />Date Inspected <br />No. 25454 <br />CUSTOMER COPY <br />