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CHART NO. <br />everett <br />11, e <br />'.'e,U <br />City of Everett ' <br />Sewer Application and Permit ` <br />No. 26990 DATE — 9L L <br />Service Address / (a C //j,'y 4 Utility Account No. <br />Billing <br />City, State, <br />Owner (Mortgagor) <br />Billing Name <br />Connection By 01, ( Eta rc t±-- <br />DESCRIPTION <br />Lot Block <br />Plat <br />Unplatted Description <br />Type Permit: Q1. n , r <br />Remarks: c.v <br />PI Pe Z'1 <br />IMPORTANT! <br />CALL 1-800424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8811 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Permit Fee_ <br />Connection <br />Total Fee_ <br />Signed <br />Sewer District <br />Monthly Sewer <br />Monthly Sewer Constr. <br />Trun <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />City Engineer <br />Issued By phiU fail /(E I. - <br />Inspection By q <br />Date I nspected��/ in <br />No. 26990 <br />CUSTOMER COPY <br />