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everen <br />e <br />City of Everett <br />Sewer Application and Permit <br />No. 26358 DATE _�.��_ .•s •�• <br />Service Address _ Utility Account <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name � <br />Connection By <br />Address <br />Phone <br />Permit Fee�_ <br />Connection Charge�s) <br />Total Fee <br />Sp�clal Dkllity TN QM. 1171-iS <br />rat�r 352.00 <br />�wr �00.00 � <br />SS2 00 r <br />Signed — <br />cu:�omer <br />DESCRIPTION: Sewer District <br />Lot =- �' a 4s Block Monthly Sewer Service <br />�8t 1.. s�1t� N� ! <br />Unplatted Description Monthly Sewer Constr. <br />Permit: <br />Remarks: <br />IMPORTANT! <br />CALL 1�800-024•555548•HOURS <br />PRIOR TO DIGGING <br />CALL2o9-8811 FOR INSPECTION <br />SEE SXETCH ATTACHED <br />Trunk <br />Lateral � ,... ,,,, <br />Abutting Lot Line <br />N S E Vy , � ^ :tS <br />/ <br />iiOtA)18� <br />F?I_[i3 4317.W <br />F'I.F.�G 830.00 <br />Approved By_� " " <br />� m 4�9.5 <br />B sRI:H i3.50 <br />Issued By `" <br />Lk2 ! 5..^O.t1(1 <br />llf�"A)�ia:7b <br />bhiT T 46ti��. W <br />R z: t3 �/[� <br />Inspection By. i:A tll� <br />Date Inspected L� y �9'a-�'n+ <br />itA"41; No��f.'2�358 <br />1�!SP[CTION <br />