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everett <br />� <br />City of Everett <br />Sewer Application �nd Permit <br />CHART N <br />� <br />,Se/z�� ;b �>f7ui-� ri'y � 2% <br />No. 25576 DATE � � �� � <br />`_. <br />Service Address � <br />% � � � , % '� ` . Utility Account No. <br />Billing Address � ' �� ' ' '� � l � � ' � `- Permit Fee <br />City, State, Zip �' ' � � � � � `- / � ' . Connectior Charyel <br />Owner (Mortgagor) � � ' <br />Billing <br />Connection <br />l'otal Fee <br />—� _ �� <br />) — <br />� , � , <br />Signed ' ' ' � �' � <br />Cuslomer <br />DESCRIPTIOi:' <br />Sewer District ��— -- <br />�ot Block_ Monthly Sewer Service. <br />�� . <br />Plat "` <br />Unplatted Description _ Monthly Sewer Constr. <br />Tvpe Permit: l��C% <br />Remarks: <br />IMPORTANT! <br />CALL 1�800-024•5555 48-HOURS <br />PRIOR TO DIGC3ING <br />CALL 259-8811 FOR fNSPECTION <br />SEE SKETCI� ATTACHED <br />F�buLing Lot l.ine <br />N,S,E,W, <br />i� � <br />Approved 8y " <br />Ciry Enginecr <br />Issued <br />Inspection By <br />Date Inspected � /z"y / <br />No. 25576 <br />INSPLCTION <br />