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everett <br />e <br />City of Everett <br />Sewer Application and Permit <br />NO. �v641 DATE <br />Service Address <br />, - w._ . � � <br />BillingAddress -- - - <br />_ . - <br />w. <br />City, State, Zip_ � <br />��'��JHIII <br />Owner (Mortgagor) <br />c <br />Billing Name <br />Connection 9y <br />Addren <br />Phone <br />DESCRIPTION: <br />Lc�t_ y Block <br />CHART NO. <br />�^' ��' C'!i ��,�%, r.- � /-13- 8 7 <br />Utility Account No. <br />Permit Fee 3�.w <br />Connection Charge(s) <br />Total Fee je.� <br />Sp�aial DLllity pee ord, 1171—BS <br />� wGr 224.Op <br />Signed <br />Cusromer <br />Sewer District_ aoee zr <br />Plat Monthly Sewer Service <br />Unplatted Description Monthly Sewer Constr. <br />Type Permit: <br />Remarks: <br />IMPORTANTI <br />CALL 1-800d24•5555 48•HOURS <br />PRIOR TO DIGGING <br />CALL 259-8811 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Lateral �����8 °�37t2M O(Mblti(�70 tatt <br />Abutting Lot Linea�'`'�yi <br />N S E W��,�R �30.110 <br />1 � `i# S ; :_''�60 h. <br />IlUn]1a39'l <br />1:1[Ki 4ti'i'.`.ill <br />PLG�i gSU.00 <br />iiECH SB1.I10 <br />Approved By—� .,� <br />f.�-:it�l �� 43.`�CI� — <br />L Sii1;11 $'IS.IX1 <br />Issued By <br />il0�Ai5t��0 - . <br />IJA1�F �pp �p <br />� $ ' ��,23 <br />Inspection By <br />Date Inspected_ /�—�`�� <br />I�SPCCiION <br />rvo. 26641 <br />