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everetl <br />e <br />City of Everett <br />Sewer Appiicatic�n and Permit <br />No. 25965 DATE <br />Service Address <br />Billing Address <br />City, State, Zip <br />CHART N0. � - �8- 2g - S <br />`; ��vr io Lf/fh.T.dC- /�j�S4 <br />Utility Account No <br />Permit <br />E.r�sr�-�U i,�ousF <br />Connection Charge�s) <br />Owner (Mortgagor) . _ le Total Fee . <br />Billing Name 11/12iNb ::�61'H OOO�lU'25'15 diK1 <br />Connection By �� : - <br />iiC�JitiioS <br />Address Signed <br />,`;[41i' s::i1.�k1 <br />cu� e� ,- • . - <br />Phone _ <br />DESCRIPTIOM: Sewer District <br />Lot ��-� Block <br />Plat Monthly Sewer Service <br />Unplatted Description Monthly Sewer Constr. <br />Type Permit: <br />Remarks: <br />IMPORTANT! <br />CALL 1-800�424-5E55 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259�8811 FOR INSPEC710N <br />SEE SKETCH ATTACHED <br />Trunk <br />Lateral <br />Abutting Lot Line <br />N, S, E, W_ ft. <br />Approved By <br />l r <br />Issued By <br />( <br />Inspection By � � <br />Date Inspected �� '7 / <br />No. 25965 <br />I fd�PCCTI [1;d <br />