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everen <br />� <br />City of Everett <br />CHART <br />5 �T` Tn �S'�'1 ti1=� <br />�• ZS-�{ <br />Sewer Application and PErmit <br />N0. 26792 DATE Auvu�t 1, 19ee <br />Service Address <br />Billing Address— «�� ,�r���r� <br />City, State, Zip <br />Owner (Mortgagor) ���i._,�� <br />Billing Name `_� <br />Connection <br />Address_ � <br />PflOflp �i 4l0. <br />DESCRIPTION: <br />Lot �6 Block- - <br />Plat -- qt�� <br />Unplatted Dascription <br />Typa Permit: y� ���� <br />Remarks: <br />IMPORTANT! <br />CALL 1-800b24-5555 48•HOURS <br />PRIOR TO DIGGING <br />CALL 259�6811 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Utility Accaunt No. <br />Permit Fee— 30.00 <br />Connection Charge(s) 7Z0.00 <br />Total Fee_ 30.00 <br />Otility p��op�aat ltis Ord, 1171-BS <br />Mt�r 17l.00 <br />�wr �71.00 <br />650..00 <br />Signed ' ' - <br />cu:tomer <br />Sewer District_ ���en�t�i0'�1� �-�b��5 �ti:� <br />Monthly Sewer Servi��5�'T6 <br />FJlil : t1�5U.p0 <br />Monthly Sewer Con�a=�r`� <br />tiE6�R i:S0.i10 <br />Trunk �#We�bn 67 {I.OD <br />i373'. �h�.Ob <br />Lateral �I�-'?�4 <br />�'. 4.t . <br />Abutting Lot LineF�� f�'� <br />N S E W rif;N #92.[N1 ft. <br />.�:. <br />o �i �.� <br />E c�:ii ��zs.c�o <br />i;�,�,:� ¢:�.ao <br />i:HECJ( !2'7a5.b7 <br />Approved By �*�� a_ ra�t. <br />c�cy e�c��e� <br />Issued By_ se■y xay0�n <br />Inspection By_Ja�� <br />Date Insoected �' a -�9 <br />INSP[CTION <br />No. 26792 <br />