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everett <br />e <br />City of Everett <br />ISewer Application and Permit <br />NO. GJ3'07 DATE pp���r ���]!LS <br />Service Address ���_�q <br />BiSling Address �pF� � <br />City, State, 'Lip �n � ��� <br />Owner (Mortgagor) J�at� a xid�l s..ti.. <br />Billing Name �� <br />Connection BY s� <br />Address ��06 Dswr <br />Phone 1s»u� <br />DESCRIPTION: <br />Lot; Block <br />Plat _ <br />Unplatted Description <br />Permit: <br />Remarl:s: <br />IMPORTANTI <br />CALL 1�SOOd24Fi555 48•HUUHS <br />PRIOR TO DIGGING <br />CALL 259�8811 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />CHART NO. <br />Utility Account No._ <br />Permit Fee �e_I�1 <br />Connection Chargels) 170.00 <br />Total Fee 30.00 <br />lw�r Dw. iw Oed !N—�� <br />esay�. �ir a..ia..o. two.00 <br />�. , � <br />Signed '�- ' `�� <br />� cmtomer <br />v <br />Sewer District <br />Monthly Sewer <br />Monthly Sewer Constr. <br />Trunk <br />Abutting Lot Line <br />N, S, E, W <br />Approved By � �, �+--�_ <br />ciry enyioee. <br />Issued By � �---- <br />Inspection By �' � • <br />Date Inspected �1 '/3• PT <br />No. 253U7 <br />INSPf_CTION <br />