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everett <br />e <br />City of Everett <br />Sewer Application <br />No. 26301 <br />.a <br />fJ <br />?ti� <br />X 4��.�na¢ilri J O <br />.�', `r��u�c ��n�i <br />� M M N M <br />anc�P�rmi� �4f4f�Q�� <br />1� py (�j V[ l 1 fV <br />f �v �,y <br />�.Nv T�i` J � '•) U] <br />P � ���� O] W � <br />DATE a <br />Service Address , <br />Billing Address . <br />City, State, Zip <br />Owner (Mortgagor) , ., <br />Billing Name � <br />Connection By_� — <br />Address a <br />Phone <br />DESCRIPTION: <br />Lot � Block <br />Plat ��,••.,_,a�� <br />Unplatted Description <br />Type Permit: <br />Remarks: <br />IMPORTANT! <br />CALL 1 �800�245555 48•HOURS <br />PRIOR TO DIGGING <br />CALL 259�6811 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />CHART N0. <br />��; ��.��: -. J-I>-8� <br />_ .� <br />Utility Account No. <br />Permit Fee yp�..- <br />Connection Chargels) <br />Total Fee <br />Sp�aial Otllitl � Ord. 1171-85 <br />wt�r 179.00 <br />' `�� 71 b0 <br />$19f1Cd ,��r, � 1� :�� ' . �.��` <br />cuscome� <br />Sewer District �d II <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Trunk 270.00 <br />Laterel 150.00 <br />Abutting Lot Line <br />N, S, E, W <br />Approved By 11ilFtD a. �aL <br />CitY En9ineer <br />Issued By gan► Batgm _ <br />Inspection By <br />Date I nspected �� Z� � <br />INSP6C'I IOid <br />�,�. 26301 <br />