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evcrefl� <br />P� <br />City of Everett <br />Sewer Applicctior� <br />NO. ���G� DATE <br />Service „ddress�g�}���{�yy�.-- <br />Billing Address���� g�.��c <br />City, State, 2ip Cwere�E-�l1�46�9� <br />Owner (Mortgage��_�p�{� <br />Billing Name ��_ <br />Connectiun By <br />CHART NO._—_ <br />SE.dT To CNq e: inlG <br />�3]S`� g� <br />i��� ��� <br />.r — <br />�. i�. : J C -`r <br />M M.�� <br />� t, <br />.� <br />� <br />� <br />�Q^ "_� <br />��i •—' �ri <br />Utility Account No. <br />Permit Fee ��..+� <br />Connection Charge�s)�__ <br />Total Fee + ..� <br />Address Signed <br />Phone��_ <br />Spectal Ut111ty Che�ge Ord. 1171-85 <br />Nater T24.00 <br />Se�re� 569.00 <br />3.0. <br />DESCRIPTION: Sewer District <br />Lot �_ Blxk Monthly Sewer Service__ __ <br />Plat y}ew�i es--B4v—� <br />Unplatted Description Monthly Sewer Constr. <br />Type Permit: <br />Remarks <br />IMPORTANTI <br />CALL 1b00�424�5555 48-HOURS <br />PRIGA TO DlGGIPIG <br />CALL259$811FORINSPECTION <br />SEE SKETCH ATTACHED <br />Trunk <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved 8y <br />pinccr <br />Issued By�.o <br />� <br />� , <br />Inspeciion By � �'��'�• .��'':��.�' <br />Date Inspected �a-.' ^' ��� <br />No. 25922 <br />li�!S� 6C'f10�: <br />