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everen <br />� <br />City of Everett <br />Sewer Application and Permit <br />CHART <br />����.� C/�.�t-=.� 7-�s 8� <br />� <br />N0. Z669Z DATE tc�v �a �v86 - I— <br />Service Address .. Utility Account No. <br />Billing Address_� — <br />City, State, Zip � <br />Owner �Mortgagor) Mi�u+ie Dern�ihv <br />Billing Name s+*e <br />Connection By w► Oon�t. <br />Address 13911 Bero 99 <br />°hone <br />DFSCRIPTION: <br />Lot <br />Plat _— <br />Unplatted Descr <br />Type Permit: <br />Remarks: <br />Block <br />IMPORTANT! <br />CALL 1�800-024-5555 48•HOURS <br />PRIOR TO DIGGING <br />CALL 259�8811 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Permit Fee 30 00 — <br />Connection Chargels) �=' <br />Total Fee ]0 00 <br />Slwcial Dtility Fea Ord. 1171-A/ <br />�Q� 471.00 <br />Signed c�:�ome� <br />Sewer <br />Monthly Sewer <br />Monthly Sewer Constr. <br />Trunk <br />l lZ.;:"btl L:-.�i ri! k riti �. tl <br />Lateral <br />i:UUI c :oY2 <br />�LNL"I' i30.Cv <br />Abutting Lot Line ' , � <br />N S E y�ts(1-� ,�t4'i1.-LN�7 ft. <br />Approved By srsmcn n �nm�* <br />CitV EnBineer <br />Issued By cn eug�^ <br />Inspection By_ � \ <br />Datelnspected '� <br />No. 26692 <br />Ii�:�PEC710"r' <br />