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i <br /> � <br /> CHART NO. <br /> everelt T� �*� <br /> � � �- �8-�0 <br /> � <br /> City of Everett � $ 8 g <br /> r��, w �� <br /> Sewer A�p�ic�tion and Permit <br /> � �� �� � <br /> NO. ����� DATE <br /> Service Addreu , Utility Account No. <br /> Billing Address _ Permit Fee � <br /> City,State, Zip a�r�.ce r� ori0� Connection Chargels) <br /> Owner (Mortgagor) ..s...� * c r�4ya Total Fee <br /> Billing Name <br /> z <br /> Connection By_. <br /> Address Signed ' �, <br /> customer <br /> / <br /> / <br /> Phone <br /> DESCRIPTION: Sewer District <br /> Lot Block Monthly Sewer Service_ <br /> Plat <br /> Unpletted Description Monthly Sewer Constr. <br /> Trunk <br /> Typa Permit: <br /> Laterel <br /> Remarks: Abutting Lot Line <br /> N, S, E, W n• <br /> Approved By <br /> ��r �o��� <br /> IMPORTANT! <br /> Issued By <br /> CALL 1-800�4245555 48-HUURS <br /> PRIOR TO DIGGING <br /> CALL 259�881'�FOR INSPECTION �� <br /> Inspection By <br /> Date I nspected �� 7��`� <br /> SEE SKETCH ATTACHED No. 27T52 <br /> I f��SPECTION <br />