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everett <br />� <br />City of Everott <br />Sewer Application and Permit <br />No. 25492 DATE Ih� �. 1�6 <br />Service Address <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Utility Account No. <br />Permit Fee <br />Connection Chargels) . <br />Total Fee ���� — <br />Sewer Developnnt Fees Ord 1171-85 <br />/Watar - 179.00 <br />s� - �n.no ■ 650.00 <br />Connection By�_ _ T <br />Address Signed P r 11 //� ' �`'� <br />Customer � <br />�10f1B <br />DESCRIPTION: Sewer District <br />Loti Block <br />Monthly Sewer Service_ <br />Plat _ <br />Unplatted Description Monthly Sewer Constr. <br />Type Permit: <br />Remarks: <br />IMPORTANT! <br />CALL 1�BOOd24-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL259id11FORINSP°CTION <br />SEE SKETCH ATTACHED <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />c�� eo <br />Issued By <br />Inspection By � <br />Date Inspected �3I8� <br />No. 25492 <br />If�SPECTION <br />