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everen <br />� <br />City of Everett <br />Sewer App'�ca4ion <br />N0. Zs6J9 DATE <br />_s <br />a, <br />_ _ _ <br />pi <br />r :i� <br />T <br />and Permit . ;5' <br />-,; =�_ <br />��= <br />N S loaP — <br />Service Address 10927 3rS � RF <br />Billing Address 1914 N 34th i3o2 <br />City, State, Zip Seattle FiI� 98103 <br />Owner �Mortgagor) �aoaerco <br />Billing Name s*+ <br />Connection By_ ��-- <br />Address �� <br />Phone sa'f-n2i� — <br />DESCRIPTION: <br />Lot .� B <br />Plat Zvi� oedwss _ <br />Ur, iatted Description <br />Type Permit: <br />Remarks: <br />IMPORTANTf <br />CALL 1-800-024�555548-HOURS <br />PRIOR TO DIGGING <br />CALL 2596817FORINSPECTION <br />SEE SKETCH ATTACHED <br />CHART <br />T P�k''� <br />3 -2� �9l <br />�au � 9 3"'•._5 <br />^^ 4: O O q (�Y • <br />�, �ti .-t C 1 � 4 17 1:� :� <br />a .n. �'. 1,� ^O �NJ <br />�F l <br />;- °� P <br />�= �;���:�-, <br />�� �- <br />.. . <br />:.�v,�rti�r�W���� <br />�Li W:� ��.�J%(.�i V <br />Utility Account No._._ <br />Permit Fee__ ao �� — <br />Connection Chargels) � <br />'�btal Fee 70 00 - <br />Special Utility Foe Ord. 1171-85 <br />water 179.OD <br />sewer 471l00 <br />650.00 � / ( <br />Signed <br />�, .�_�1 rl i, ,. ,(� <br />cu:tomer <br />Sewer District - <br />Monthly 3ewer <br />Monthly Sewer Constr. <br />Trunk 336.00 <br />Latera <br />Abutting Lot 1_ine <br />N, S, F, W <br />Approved By „ <br />Ci y n m_er <br />Issued By_ <br />Inspection By � <br />Date I nspected �` � �' �� <br />N0. c�.�l�`�� <br />I i.SPGCTION <br />