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eve�ett <br />e <br />City of Everott <br />Sewer Appli�ation and Permit <br />NO. �Sv41 DATE <br />, <br />5ervice Address �.+��.#}K� <br />Billing Address ����T�����_ <br />City, State, Zip E���yTqdZgS <br />Owner (Mortgagor) . � <br />Billing Name _ <br />Connection By <br />Address <br />Phone <br />DESCRfPTION: <br />Lot � Block <br />Plat — ,�"---� ���lt! <br />Unplatted Description <br />Permit: <br />Remarks: <br />IMPORTANT! <br />CALL 1SOOd24-5555 48•HOURS <br />PRIOR TO DIGGING <br />CALL 259�8811 FOR tNSPECTION <br />SEE SKETCH ATTACHED <br />CHART <br />,�'.�.T J� cF/sl,e� dcr .b/ 3/a6 <br />4HY ��5?'��iT�'_�i.si <br />s.3s».00 <br />�c►i :ie.00 <br />Utility Account No. k wn+ �� �L <br />E :iRCll £15.(i0 <br />Permit Fee_F,��.�{{ �l�g ,,�, <br />IX21hPl f^O.UO <br />Connection Chargels►��oq�,��� <br />s��i� ssu.a� <br />Total Fee �a,� �p�pp <br />Itf10(I�xl'.0 <br />Speclal Serer t�� Or�f�F111-e5 <br />Mat 79;W�•� <br />Sewar - 471.00 <br />, <br />Signed � —i�� <br />CUSIOTlf <br />i�• <br />Sewer <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Trunk <br />Lateral <br />Abutting Lot Line <br />N� S� E� W-- <br />Approved By <br />v <br />Issued By <br />Inspection R ��eS/ � / <br />Date I nspected �- 2 2`�� <br />I N:;P ECTI ON <br />No. 25641 <br />