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evei'ett <br />� <br />City of Everett <br />Sewer Applicction and Permit <br />Na. 27639 DATE _L�ch_15.–�nno <br />Service Address i i�'+� �� ni cr <br />BillingAddress »F�S •� rtir a a.qyray <br />City, State, Zip *,;ra_u�l vn oen» <br />Owner (Mortgagor) n�+h = m.� • n...�.�� — <br />Billing Name <br />Connection By �z � +� � -- <br />DESCRIPTION: <br />Lot <br />Plat <br />Unplatted Descr <br />Permit: <br />Remarks: <br />Block <br />IMPORTANT! <br />CALL 1-800-424�5555 48•HOURS <br />PRIOR TO DIGGIVG <br />CALL 259-8811 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />CHART <br />Utility Account No. <br />Permit Fee +� <br />Connection Chargel <br />Total Fee_�n,.n <br />TO �s i t?J5 <br />5 - 'iE3-`X"� <br />v:�'i', �ti1 .;i:l�;�d; ri�tilBt�aoi <br />!:(u:',_75:i9 <br />� �,;,; :,o.c� <br />rir�rt� : ��1.��^ <br />Signed -" <br />Cusiamer <br />$�WCf �ISifIC[ <br />Montlily Sewer Service <br />Monthly Sewer Constr. <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved 8y rT�oun R 'rrinnr. <br />CitV EnB ncer <br />Issued By T TM+�ti��� <br />/l,. , / �- i <br />/ <br />Inspeciion By� _ � <br />Datelnspected � �� � G� <br />rvo. 2763� <br />If�!�PE�:'i IGTi <br />