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everett <br />� <br />City of Everett <br />Sewer Application and Permit <br />l.. � _ - __ <br />CHART NO. <br />I� - _ _ . <br />NO. v� v DATE J� a- l— <br />02.. y�t'oc C��,,[L�� <br />Service Address 3 lo O � p QY�J � Utility Account No. <br />Billi�r Address <br />City, SWte, Zip <br />Ovmer (Mortgagor) <br />Billing Name <br />Connection By <br />Address <br />Phone <br />DESCRIPTION: <br />Lot <br />Plat <br />Unplatted Descr <br />Block <br />CALL 1-800�124-5555 48•HOURS <br />PRIOR TO DIGGING <br />CALL 259�8611 FOR INSPECTION <br />SEE 3KETCH ATTACHED <br />Permit Fee <br />Connection Charge(s) <br />Total <br />Signed <br />cu:,omer <br />Sewer <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Lateral <br />Abutting Lot Line <br />N, S, E, W, <br />.,�� i J�' <br />Approved By <br />City Engmett <br />ISSUOd By <br />Inspection By�-�? 3— �`� ' �% <br />Date I nspected 1'� � �� � �� � <br />. � :.r� ..,� <br />NO. � ` <br />y �.I V J <br />� o--,...-� �..�.. <br />�����.,ci,�.., . <br />