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everetl <br />e <br />City of Everott <br />Sewer Applicction cnd Permit <br />NO. 25v47 DATE <br />Service Address�L�---�.�--"^=^+ <br />Billing Address . ) : ;", — <br />City, Sute, 2ip - �- t j-i '� <br />Owner (Mortgagor) � ' � `� % ' <br />Billing Name '' � ' — <br />� <br />Connection <br />Address <br />� <br />Phone � �� '� 1 <br />DESCRIPTION: <br />I_ot --- <br />Flat - <br />Unplatted Descripti� <br />Typa Permit: <br />Remarks: <br />Block <br />IMPORTANTI <br />CALL 1�00�424-5555 48•HOURS <br />PRIOR TO DIGGING <br />CALL 255�8611 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />CHART NO. �Z� 5 <br />�`�G� ���� g� <br />Utility Account No. <br />Permit Fee �� �_ <br />Connection Charye�s) <br />Total Fee ,,�� �r <br />� l -----� , <br />� 11, �, �'I i � � . ��, � <br />Signed f� �� ,— <br />cu:tomer✓ � <br />.l <br />Sewer <br />Monthly Sewer <br />Monthly Sewer Constr. <br />Abutting Lot'Line <br />N, S, E, W. <br />Approved By ' _ �' " � <br />Ciry EnqineM <br />Issued By --y�` <br />� <br />InspectionBy� "'���/'�`` <br />Date I nspected � �r�� <br />No. 25Ei47 <br />INSP[CTION <br />ft. <br />