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ever�n <br />e <br />City of Everett <br />Sewer Application and Permit <br />CHART <br />j.,� T .�!�-, ��G1%!r� � , � Y q� <br />NO. 27Q13 DATE �.e..trr 14, loaa � <br />Service Address u� ��� � Utility Account No. <br />Billing Address �� ��1 <br />City, State, Zip ��lt 11� 96201 <br />Owner (Mortgagor) �k �� <br />Billing Name � <br />Connection By n� ��r=�+ <br />Phone �]7-4577 <br />DESCRIPTION: <br />Lot <br />Plat <br />Unplatted Descr <br />Permit: <br />Remarks: <br />Block <br />IMPORTANTI <br />CALL 1�800�424•5555 48•HOURS <br />PRIOR TO DIGGING <br />CALL 259EE�1 FOR INSPECTION <br />' �. <br />SEE SKETCH ATTACHED <br />Permit Fee �� � <br />Connection Chargel <br />Total F <br />� ,.\ ; i <br />Signed �l ' T.`.--�"�-` ` <br />cu:tomer <br />Sewer <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Lateral 1c^I1S/tiF3 Ls40FH OOORN.',4�.19 tYl:k <br />, <br />, <br />Abutting Lot Line b� �13 <br />N S, E, W�.��7�t�_ ft. <br />Approved By <br />citV npmeer <br />8i1t1 EiO�C <br />I ssued <br />� ` <br />Inspection By�'1 ,_ • �� <br />Date Inspected�� �/9� <br />No. 27013 <br />WSP6CTION <br />