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eve�ett <br />e <br />City of Everett <br />Sewer App�ication and Permit <br />N0. ?�40� DATE q' Zq �SB <br />CHART N0. M <br />���� <br />Po Si� �-D `� � �9 K 1+ <br />� �I MMS �OMPLE'T�E <br />Service Address 3�'�' � � � O G K Ci�� L e,C Utility Account No. <br />Billing Address Permit Fee <br />City, State, Zip Connection Charge( <br />Owner (Mortgagor) <br />Billing Name <br />ConnectionBy C�f"�/ O� CVGYe�'�' <br />Address <br />DESCRIPTION: <br />Lot <br />Plat <br />Unplatted Descr <br />Type Permit: <br />Remarks: <br />Block <br />J � <br />� ., <br />O o <br />�� 6 �6 C <br />n <br />/, 3 ' t� <br />�,L'�� 3 <br />IMPORTANT! <br />CALL 7b00-024•5555 48�HOURS <br />PRIOR TO DIGGING <br />CALL 259�8811 FOR INSPECTION <br />SEE SKETCH ATTACHEO <br />Total <br />Signed <br />cuncomer <br />Sewer Distr <br />Monthly Sewer � <br />Monthly Sew�; Constr. <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />City Enpineer <br />IssuedBy �dN %�� �I�Y <br />Inspection By � <br />Datelnspected <br />r r � .. ,1 <br />N0. �i7�„I . <br />CUS i Ci�.iGR COP�r' <br />