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everett <br />e <br />City of Everett <br />Sewer Application and Permit <br />CHART <br />�i-���J!D C/(�a/.��.: <br />�(� / G %/B 8 <br />I <br />NO. �s`��� DATE Jaeaae�r �6, 1fM � <br />Service Address �� �� aa Utility Account No. <br />Billing Address � <br />City, State, Zip ��c�_ �a �w�n� <br />Owner (Mortgagor) w� �+�+ <br />Billing Name =�. <br />Connection By �—� <br />Address <br />Phone ��,��+• <br />DESCRIPTION: <br />Lot 1�� Block <br />Plet +�� �+� <br />Unpiatted Description <br />Permit: <br />Remarks: <br />IMPORTANT! <br />CALL 1�800d24-565548-HOURS <br />PRIOq TO DIGGING <br />CALL 259�8811 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Permit fee m•� <br />Connection Charge(s) 2�•� <br />Total Fee �•� <br />Oedlsanw 1171-YSe <br />N�wr 100.00 <br />n.cu u�.ao <br />SS2.00/ - <br />Signed :. / r'-� , —, �G'�L <br />customer <br />Sewer District �� u <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved By�,��A�k <br />� <br />Issued By �51�4�Led-- <br />Bff) ll 1'''iO.Op <br />1�71-5A R5.`"'►,;,�II) <br />� 'd4�OD <br />Inspection By <br />Date I nspected a'� �"�� <br />INSPECTION <br />NO. Z6`71% <br />