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everett <br />e <br />City of Everett <br />Sewer Application and Permit <br />N�. Z6OS1 DATE <br />. <br />Service Address �gr��*g� Utility Account <br />Billing Addres5� � s-.- ++. <br />City, State, Zip����yg�yp <br />Owner (Mortgagor) _ __ <br />Billing Name�� <br />Connection By �� _ <br />Address� ___ <br />Phone �..+ . �++ <br />DESCRIFTION: <br />Lot�— Block_�__ <br />Plat �p��_ _ <br />Unplatted Description_ <br />Type Permit: �� � __��__ <br />Remarks: <br />IMPORTANTI <br />CALL 1-800-024-5555 48•HOURS <br />PRIOR TO DIGGING <br />CALL 259�8611 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />CHART N <br />;�.-- : �, c,�-.� �.,��� _ <br />S �.�-.�-, <br />Permit Fee�� <br />Connection Charge�s) • O <br />Total Fee <br />Speelal Ut111ly Fee OrA. 1171-�5 <br />xate� 152.00 <br />seaer 400.00 <br />5� <br />Signed <br />cu:romer <br />Sewer District <br />on <br />PAonthly Sewer Service <br />`Aonthly Sewer ConsU'. <br />Lateral <br />Abutting Lot LinN�= ji;�7? 1;.:19fd' (�']OAN4CY1: tit� <br />N, S, E, W ' _ft. <br />A : LiJ <br />I �.��i �.ii�1.�N� <br />i 11.f'�C f'tQ.Of <br />rtEI;H il +.lh� <br />I'1.11 GH 4iG.:5; <br />Approved By - <br />, y�e <br />F. �•�:(.�ii L 1 J.1111 <br />Issued By �'ti�' ��U.(n: <br />I.AiTF:f.: �4U[J.(A� <br />lNk.�f.l`Gi <br />� .SF:4.q . � .rU.txl <br />I Inspection By � ` ' ' — <br />�,,��,j'� s,.. �.tn.� <br />Date Inspected_��'•� <br />�z-- <br />No. 26061 <br />I i�!: PCCTI OPJ <br />