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everett <br />� <br />City of Everett <br />Sewer Application an� Permit <br />NO. ��TJ� DATE _ <br />Service Address g,�g -•-- --. <br />Billing Address . <br />City, State, Zip � A��e - <br />Owner (Mortgagor) <br />CHART NO. <br />��,v � "TO r�S"C JJ4 <br />�• ZS-04 <br />Utility Account No. <br />Permit Fee <br />Connection Charge�s) <br />Total Fee <br />Billing Name vtiliip DonlopMot M ord. 1171-t5 <br />Nt�r 179.00 <br />Cunnection By �r � �71.00 <br />650.0�/25/88 2�14PM f100R#2186 i3it <br />Address Signed � �"'-' <br />c�Q{�+gy <br />Phone B1.DG S12D.15 <br />6 3(tCH 4's.:-0 <br />DESCRIPTION: Sewer District �"�' '���-� <br />Lot___� _$� Block_�- Monthly Sewer Serv(iiER s� � <br />Plat - �s--- -�- - 1171-5 fF50.OD <br />Unplatted Description Monthly Sewer ConllilOQO''Y46 <br />WiTF.R l60.00 <br />Trunk IICY101317i <br />Type Permit: LWT.20 Ri131.W <br />Lateral GA�1 i3�14_E_5 <br />Remarks: <br />IMPORTANT! <br />CALL 1-600-024•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, W <br />Approved By <br />Issued By <br />Inspection By��'�`�`"`" � <br />Date I nspected �-.� � - -�� <br />INSPrC7'ION <br />No. 26756 <br />