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everetl <br />e <br />City of Everett <br />� <br />: <br />� <br />� �� <br />�, � • <br />., <br />J � <br />N <br />� <br />Sewer Application and Permit� . ;� � <br />N0. 267�6 <br />�..o `� u .'� <br />� � <br />DATE �s.y�6 l�ea � <br />Service Address <br />Billing /lddress - <br />City, State, 2ip <br />Owner (Mortgagor) • <br />Billiny Name :�� <br />Connection By �� �K <br />Address S�i2 Lft1 ,w �s rl ata*w <br />Phone •u �� <br />CHART <br />Utility Account No. <br />Permit Fee �o � <br />Connection Charge(s) <br />Total Fee ln o0 <br />Signed <br />DESCRIPTION: Sewer District <br />Lot � Block Monthly Sewer Service <br />Plat __�r � <br />Unptatted Description Monthly Sewer Constr. <br />Type Permit: <br />Remarks: <br />IMPORTANT! <br />CALL 1�800�424-5555 48•HOURS <br />PRIOR TO DIGGING <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved By ��+*� � 19L��- <br />Ciry EnBineer <br />Issued By �;�4�^ <br />CALL 259�8811 FOR INSPECTIUN <br />I ns��ect i o n <br />SEE SKETCH ATTACHED <br />Date Inspected <br />NO. Zv�Ov <br />li��i:�i GC'll0i�; <br />R <br />