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everett <br />e <br />City of E��erett <br />Sew�r I�lppiica�don and Permit <br />CHAP,T NO. <br />.se�� t � �;��,-t,�y ����y <br />NO. LJJOo OATE trres li, 19i6 I <br />Service Address 1�2 -�� A� � Utility Accuunt No. <br />Billing Address �81�i-�iiQDili�ti Permit Fee 30.,..r. <br />City, State, Zip �. � 95040 <br />Owner (Mortgagor) Co18a► tioN Baild�a <br />Billing Name Gold� B�e Doild�rs <br />l;onnection By_ �ld�n llo� �i1E�zs <br />Addreu iZ7i Olj��io �'�r D�, e- <br />Phone �+�_�,., <br />DESCRIPTION: <br />Lot �� Block <br />Plat ��¢�� ...� .. <br />Unplatted Description <br />Permit: <br />Remarks: <br />IMPORTANT! <br />CALL 7�800�424-5555 48•HOURS <br />PRIOR TO DIGGING <br />CALL 259�8611 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Connection Chargels)�p�pp_ <br />Total <br />Sewr D�a�lapmant !'�e. O:dinenca 1171-85 <br />1Pat�z 152.00 <br />swaz 4�00.00 <br />/ � 552.00 <br />I . R .. <br />Signed -- <br />cu:tomer <br />Sewer District <br />Monthly Sewer Service <br />Monthiy Sewer Constr. <br />Trunk <br />Lateral_ <br />P.butting Lot Line <br />N, S, E, W_ <br />Approved By <br />�tY npinex <br />Issued By ��g�t �ni,�o+� <br />r <br />Inspection By � <br />Date Inspected 5 �` <br />No. 25508 <br />ir��r�r-c�rton� <br />