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4 <br />everett <br />e <br />City of Everett <br />Sewer Application and Permit <br />No 26992 DATE �P <br />Service Address 19.51 <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Connection By <br />Phone <br />DESCRIPTION: <br />Lot <br />Plat <br />Unplatted Descr <br />T...... Dn....-t• 1� <br />Block <br />Remarks: <br />,+ Uw <br />G <br />IMPORTANTI <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259.8811 FOR INSPECT .ON <br />SEE SKETCH ATTACHED <br />CHART <br />Utility Account No. <br />Permit Fee <br />Connection Charge( <br />Total Fee <br />Signed <br />Customer <br />Sewer District <br />Monthly Sewer Service. <br />Monthlv Sewer Constr. <br />Trunk <br />Lateral <br />Abutting Lot Line <br />N,S,E,W <br />�, t <br />Approved e*✓ <br />r ty ngineer <br />Issued By <br />Inspection By ��! <br />Date Inspected � " alp---`L <br />No. 26992 <br />CUSTOMER COPY <br />