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evereR <br />� <br />City of Everett <br />Sewer Application <br />No. 25761 <br />o �Te _ <br />CHART <br />�;�=,r�r To G,�r�� ; .�ic- ic i �sh <br />g� <br />O .p-� <br />M y, <br />�t <br />•o u <br />.r <br />+-1 <br />��.�i�i c� <br />� � <br />Service Address ie9aa _�r� ww rs __ Utility Account No. <br />BillingAddress �'+» —�ta�ti o� ar _ Permit Fee �•� <br />City, State, Zip_iy��d� rn orma�_ Connection Charge�s) 330.00 <br />Owner �Mortgagor)_�orns e o.... [Y,...t CnrQ <br />Billing Name �.... <br />Connection <br />Pl�one ;,��_ __ <br />DESCRIPTION: <br />Lot 19 Block <br />Plat �■��*Mk ni� �2 <br />Unplatted Description _ <br />Type Permit: <br />Remarks: <br />Nor tbnnoction <br />IMPORTANT! <br />CALL 1-BOOd24-5555 48•HOURS <br />PR10R TO DIGGING <br />CALL 2599811 FOR I�SPECTION <br />SEE SKETCH ATTACHED <br />Total Fee___ 30.00 <br />Sp�cial fN�, Ordinance 1171-85 <br />raler 179.00 <br />s�rer 471.00 <br />650.00 <br />Signed <br />Customer <br />Sewer District �nd III <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Lateral <br />Abutting Lot Line <br />N, S, E, W. <br />Approved BY �L��++ R tHF.�i- <br />Ciry EnBinecr <br />Issued By u��q�et g r,.r,�...� _ <br />Inspection By _ <br />Date l nspected� /� <br />No. 2576i <br />IPJ.`;?; CT!C� <br />