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everetl <br />� <br />City of Everett <br />Sewer Ap�slication and Permiit <br />N0. GG71O DATE T,.+�e 3 ton�t <br />Service Address <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor�_ <br />Billing Name <br />Connection By <br />Address <br />Phone <br />DESCHIPTION: <br />Lot 17 Block <br />Plat '�+�+ r + <br />Unplatted Description <br />Type Permit: <br />Remarks: <br />IMPOR.ANT! <br />CALL 1500-024-G555 48�HOURS <br />PRIOR TO DIGGING <br />CALL 259-8811 FOR INSPECTION <br />SEE SKETCH AT7ACHED <br />Utility Account No. <br />Permit <br />Connection Charge�s) <br />Total Fee <br />Syecial Utllity Fe� Ozd. 1171-85 <br />ffI wator 179.00 <br />sewcr 471.00 <br />� 650.00 <br />i i <br />Signed _ <br />Sewer District <br />Monthly Sewer Service <br />ubr'u'i;l�:t fl:fl4fdi O�p,Y�{,�lot:` 3:I:; <br />_ Monthiy Sewer Constr. <br />i;1;U11: ..ii"Y <br />— Trunk �-.3� so.n4-•�.{�— <br />11.[;i; t�;;;.GJ <br />Lateral <br />�; �.�:�if ".3.`.if? <br />Abutting Lot LineC Sr•+_il ?I:;.UO <br />N S, E, Wtria.ii� r•�•n 1➢l ft. <br />i;Clua'l,7p1 <br />`;.4?;. ,;I).1�8 <br />iii��l!i ,.;:'.Il.1�S <br />�;;1—'� :r.iJ�.t41 <br />Approved By ` `' ' <br />� . , IY_, . ngineer t GU.I.i� <br />� ilt l.l. 1 li:'I�i,SU <br />Issued By <br />Inspection By — <br />Date Inspected �'D <br />Np. 2671� <br />I(�!�;'�CT!OP.I <br />