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everett <br />e <br />City of Everett <br />Sewe� Applic�tion and Permit <br />CHART N0._ — <br />_; , / ./- U�, � r.' : ; /-� ,s -, ; � <br />NO. 26610 DATE _ �urch 3�. i�a I� <br />Service AdJress Utility Account No. <br />Billing Address , <br />City, SWte, Zip�_ <br />Owner (Mortgagor)�.�t� <br />Billing Name <br />Connection By� <br />Address�— <br />Phone���— <br />DESCRIPTlON: <br />Permit Fee �p.D� <br />Connection Charge(s) ���- <br />Total Fee +n ne <br />Sp�cial IJtility !N OrA. 1171-85 <br />water 224.00 <br />Signed <br />cu:tomer <br />Sewer District �d tI <br />Lot_..i_ Block Monthly Sewer Service <br />Plat <br />Unplatted Description Monthly Sewer Constr. <br />Type Permit: <br />Remarks <br />IMPORTANT! <br />CALL 1500-424-5555 48•HOURS <br />PRIOp TO DIGGING <br />CALL 259�8817 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Trunk <br />�}};'1�:/i:8 ":4,�rii ODOAMOI`SI I'EBS: <br />Lateral '�U'�oi;lU <br />71 � 1-5 i2�4. (10 <br />Abuttin9 Lot Line;;�p�nl�„gy <br />N, S, E, W,ja1j1FF' 4.:0 iN ft. <br />AlH u)1976 t <br />I;L[Ni �472.U0 <br />!'t_I,i; SEW.IxI <br />ii�i�'JI S42.O11 <br />Approved By �'� '"'� � g� <br />��'hii. �mcer 9.{,`..d1 <br />i. 5!;ill sILLt�II <br />Issued By� �'�F��z�y�'�� <br />l:111_�{: i�lv i �.1;i1 <br />Inspection By ��-� <br />Date Inspected_��/a'r <br />li::_�i'rC i lOiJ <br />N0. 26610 <br />