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P.VC�C11 <br />e <br />City oi Everett <br />� Sewer Ap�!ica+�ion and Permit <br />CHART N0. <br />S�ar � CN9��r%r�� a/s/�� <br />No. 25462 DA'�E !�b' 1�• 19l6 I <br />L— <br />2561 1Mt! Mdciltw sl�d. Utility Account No._— <br />Service Address <br />Billing Address <br />220 76tA 8tswt 8.11. Permit Fee 30.00 <br />City. State, Zip <br />rier�tt, 1h. le203 Connection Chargels) �20'� <br />]0 00 <br />Owner (Mortgagor) �� �� <br />Billing Name S� <br />Connection <br />�ss-a aioe <br />Total Fee <br />OrAiau�oe 1171-85 <br />xaL�r 2��.00 <br />'S�wr 599.00 , <br />,/ 813.00 <br />Signed r.' ,�;�� ir C,�`��r. <br />� Customer <br />Phone <br />�oe►d II <br />DESCRIPTION: Sewer District <br />Lot 9 _ Block 2— Monthly Sewer Service 6.50 <br />Plat �l1nt°° <br />Unplatted Description Monthly Sewer Constr. <br />_ , 270.00 <br />Type Permit <br />Remarks: <br />llar Ocmn�otim <br />IMPORTANT! <br />CALL 1�800-024•5555 48•HOURS <br />PRIOR TO DIGGING <br />CALL 2595811 FOR INSPECTICN <br />SEE SKETCH ATTACHED <br />�50.00 <br />Abutting Lot Line <br />N, S, E, W <br />Approved B� R "'�'� <br />City Engineer <br />Issued Bv E• eOOd <br />��ii(✓'�`% 1- S: <7 <br />Inspectiun Bry <br />Date Inspected_ <br />No. 25462 <br />inst�ec i ior� <br />