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CHART NO. - <br />everett <br />City of Everett <br />Sewer Application and Permit <br />No. 261aT DATE _11pti1 lfi, 1187 _ I___ <br />Service Address µg+ It&Impkes I Ve -- Utility Account No <br />Billing Address <br />City, State, Zip <br />Owner (Mort(jagor) <br />Billing Name manse <br />Connection By— ntftc-.— <br />Address� <br />Phone <br />DESCRIPTION: <br />Lot Block <br />Plat <br />Unplatted Description_ <br />Type Permit: <br />Remarks: <br />IMPORTANT! <br />CALL 1-800424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259ft11 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Permit Fee 10.00 _ <br />Connection Chargei <br />Total Fee_ 10.00 -- <br />Signed <br />Customer <br />Sewer District <br />Monthly Sewer Service_ <br />Monthly Sewer Constr. <br />Trunk <br />Lateral <br />Abutting Lot Line <br />N, S, E, W_ <br />04/15i87 211W11 WORM4698 1*t; <br />960126147 <br />Approved Byl:"�*� <br />npineer tr.'ee� <br />t111. ;k 110.00 <br />ISSL'ed By gLxj-Xsu9An — <br />Inspection By�� <br />Date Inspected_ 4*5-23,7 <br />No. 26147 <br />INSPECTION <br />