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everett <br />e <br />City of Everett <br />Sewer Application and Permit <br />NO. 27006 DATE <br />Service Address his Olsw <br />Billing Address <br />.a • w r� 9SOu — <br />City, State, Zip <br />Owner (Mortgagor) _. ^"�'•""��"� <br />Billing Name <br />Connection <br />CHART <br />Sct-y'r TD 'F;er� pr,, <br />g•zs-act <br />Utility Account NO. <br />Permit Fee <br />Connection Charge(s) <br />Total Fee <br />Ort-dinatner 1171—BS t <br />water 224.00 <br />Dolor 5".00 <br />13.00 <br />Signed 4tvk1 <br />f <br />— >efomm !Ip0lul�il <br />Phone <br />DESCRIPTION: ■ <br />t�tx; sesr.ou <br />Sewer District <br />Block 11 <br />Lot Monthly Sewer Serve' _ u <br />Plat a' T al '1i•W <br />Monthly Sewer ConsR Unplatted Description LL ! fn.00 <br />Trunk t* J t-V.00 <br />Type Permit: Lateral $30.00 <br />= <br />1171 u W13.00 <br />Remarks: Abutting Lot Line IIOf"146 ft. <br />N, S, E, WAOER <br />OfF.01 t 041.5,5 <br />Approved By <br />IMPORTANT! Issued By <br />CALL 1-800.424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259.8811 FOR INSPECTION <br />Inspection By <br />==]Date Inspected <br />SEE SKETCH ATTACHED <br />No. 27006 <br />INSPECTION <br />