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everetl <br />� <br />City of Everett <br />Sewer Application and Permit <br />CHART NO. <br />`�, J,..�-.�n �'%1 G,��c I <br />i� y�'-��gR <br />No. 26512 DATE Ou�.�.r.. �n. ��an � <br />$ervice Address ]611 l�cl�r Utility Account No. <br />Billing Address �... — <br />City, State, Zip ��tt. V 9�201 <br />Owner (Mortgagor►_�y ot ��tt <br />Billing Name ��. <br />Connection By yt s..� <br />DESCRIPTION: <br />Lot <br />Plax <br />U�platted Descr <br />Type Permit: <br />Remarks: <br />IMPORTANT! <br />CALL 1�800-024-555548-HOURS <br />PRIOR TO DIGGING <br />CALL 259�6811 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />� <br />Permit Fee 2-t� <br />Connection Charge(s) <br />Total Fee � sn <br />Signed ' <br />Customer <br />$CW@f � <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Trunk <br />Lateral <br />Abutting Lot Line <br />N, S, E, W k. <br />U1/:`U/� 1�:5l7F't1 (1OD11Ufl73.''S tJat <br />t�1QD26512 <br />SElaEEih <br />Approved By ;�.,r�1.:1� <br />i v nymeer <br />Issued By �y �y�_ <br />Inspection By <br />Datelnspected <br />No. 26512 <br />1(`!SNIcCT10�^J <br />