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tverett <br />� <br />City of Everett <br />� �� <br />CHARi <br />Sewer Application :ar�d Perr�it <br />i - , 1 <br />'.i�J <br />NO. ���oo DATE ` _ _btarch '�2 199c. <br />Service Address__�n; , Utility Accouni No. <br />Billing Address <br />� City, Stote, Zip , , <br />Owner (Mortgagor) — <br />Billing Name <br />Connection By�—��y�ry <br />DESCRIPTION: <br />Plat _ <br />Unplatted <br />Type Permit: <br />Remarks: <br />Block <br />IMPORTANT! <br />CALL 1-800-024�5555 46�HOURS <br />PRIOR TO DIGGING <br />CALL 259-8817 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />� t�snr�+c., <br />5-�6-9c� <br />Permit Fee 30.G0 <br />Connection Chargel <br />Total Fee <br />Signed <br />Customer <br />Sewer Distr <br />Monthly Sewer Service — <br />Monthly Sewer Constr. <br />Lateral_ <br />Abutting Lot Line <br />N, S, E, 'vV <br />Approved BY__ '��°� 72 THE7�L <br />Cit� . • cr <br />Issued By ..av Aauaen <br />� �i .i <br />�� � �, i <br />Inspection B _, - � ,� .� <br />—, � ,/G <br />Datelnspected � ' � L( �� <br />� <br />N0. 276�0 <br />I i��f GC I I ON <br />� <br />