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CHART N0. <br /> everetl <br /> � SEiv?' ?a C�iJ�b�',t/v <br /> y 2 g� <br /> City of Eve►ett <br /> Sewer Applitation and Permit <br /> No. 25564 DATE ' ' i — <br /> Service Address � � ' �-- Utility Account No. <br /> ,__---- <br /> Billing Address ' � � Permit Fee <br /> City,State, Zip � � �- ' ' Connection Charge�s) � <br /> . <br /> — i .--- <br /> Owner (Mostgagor) � ' J ' Total Fee <br /> Billing Name � <br /> Connection By _ <br /> Addre<5 Signed,� <br /> :v''�� / ' <br /> � Cust mer <br /> Phone '� - —-- <br /> DESCRIPTION: Sewer District — <br /> Lot Block <br /> Monthly Sewer Service — <br /> Plat <br /> Unplatted Description Monthly Sewer Constr. <br /> Trunk l <br /> Type Permit: /!� <br /> Lateral <br /> Remarks: <br /> Abutting Lot Line <br /> N, g, E, W ft. <br /> Approved By <br /> Ciry Enginee: <br /> IMPORTANT! <br /> Issued By <br /> CALL 1-800-024�5555 48•HOURS <br /> PRIOR TO DIGGING <br /> CALL259S811FOR WSPECTION . <br /> Inspection Ry <br /> Datelnspected ���� <br /> SEE SKETCH ATTACHED No. 25564 <br /> INS^ECTION <br />