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everetl <br />� <br />City of Everett <br />Sewer Application and Permit <br />CHART N0. <br />j c-�a( fn C�lC. tT>Yr I . i Z'1-.� `% <br />NO. 27�21 DATE _��r 29. 198s � <br />Service Address ygu}F p��d rm, Utility Account No. <br />Billing Address +a+• �—��dw�r— <br />CitY. State, ZiP ��tL, 111 90�6} <br />Owner (Mortgagorly��1� �-- <br />Billing Name �_�--- <br />Connection By �— s -- <br />Phone <br />DESCRIPTION: <br />lot 9-lo Block � <br />Plat .. a.,.., r_..., .� � .�. <br />Unplatted Description_ <br />�e Permit: <br />Remarks: <br />IMPORTANT! <br />CALL 1�SOOd24•5555 48•HOURS <br />PRIOR TO DIGGING <br />CALL 259EBT1 FOR INSPECTION <br />SEESKETCH ATTACHED <br />Permit Fee 30.0� <br />Connection Chargels) Ne�+e <br />Total FE <br />tttility '�w��opment Fee Or�. 11�1-i�c e5 <br />♦rater 179.00 <br />sarer 471_00 <br />650.00 <br />Signed — <br />Cuslomer <br />Sewer District �L' �� °�' ���� '��'7 Ct i'. <br />Monthly Sewer Servl��� �'"� � . <br />Monthly Sewer i,on��r� ' �'�•�� <br />iil:CH 4�4.fxi <br />Trunk �'� N I:N 8�a.��:, <br />�: .L� . <br />Laterel � `�<<�N �'Z�•� <br />ui: .� .�u <br />Abutting Lot Line ����k �," <br />�h1TCl' S651i.i�l ft. <br />N, S. E, yy .. _ <br />;� <br />SEWfF 3"s0.t7i1 <br />t l'1 � '�i�S0.U0 <br />LIfGLY Fitt57.�!`I <br />Approved By 1��D R. TttEt►i. <br />Ciry Ei�7ineer <br />Issued By ��y y���q�d <br />Inspection� ��' <br />Date Inspected 3 �y �� '�� � <br />No. 27021 <br />I;::.�PECTI(�i! <br />