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everen <br />e <br />City of Everett <br />Sewer Applicatian and Permit <br />NO. L76��' DATE ranrrh ?3 �oop <br />Service Address uua '�3 rl Sa <br />Billing Address 9�' <br />City, State, Zip ���rett, kA 98208 <br />Owner (Mortgagor) N��n ��'e1 <br />Billing Name <br />Connection By <br />DESCRIPTION• <br />Lot <br />Plat <br />Unplatted Descr <br />Type Permit: <br />Remarks: <br />IMPORTANT! <br />CALL 1�800�424-5555 48-HOURS <br />PRIOR TO DIGGING <br />Cl1LL259�8617�FOR INSPECTION <br />SEE SKETCH ATTACHED <br />CHART <br />—� rb sT nls. <br />'-� - -18 - 90 <br />Ui%:::,%"i� 1.':0'il'ii �i(tpilef0iti9 <br />/ <br />�;Gi?Q:"IM`.�(; <br />�,r�n.r >�so.�a� <br />tliCll: +'U.00 <br />Utility Account No. <br />Permit Fee ;p,�� — <br />Connection Charge(s1 — <br />Tntal Fee 3p.�� — <br />Signed <br />cu:�omcr <br />SeWCf <br />Monthly Sewer <br />Monthly Sewer Constr. <br />Abutting Lot Line <br />N, S, E, W. <br />Approved By <br />� �a� e <br />Issued By d iloelewe'� <br />r�!.: <br />� ,%,�j�-�- / <br />�spection By <br />_ .—� <br />,, Date I nspected � •2 � �7 <br />N0. 27668 <br />I�SPCCTIO"1 <br />