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everen <br />e <br />City of Everett <br />5 ��+ver Application and Permit <br />N0. 269Z9 DATE �a...►„� a i9se <br />Service Address <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor► , <br />Billing Name <br />Conne�ction <br />Address <br />Phone <br />DESCRIPTION: <br />Lot -- <br />Plat <br />Block _ <br />Utility Account No. <br />Permit Fee <br />Connection Charge(s) u�..� <br />Total Fee_ 1n_ne <br />` j <br />Signed � ✓�" �', <br />� � c�.—ro���/ �l <br />Sewer District a�..w tr <br />Monthly Se�ver <br />Unplatted Description Monthly Sewer Constr. <br />Permit: <br />Remarks: <br />IMPORTANT! <br />CALL 1�00�424-5555 46•HOURS <br />FRIOR TO DIGGING <br />CALL 259�SG'.7 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Trunk <br />11/Uii&0 is4BrN W[Ii1k3283 tZii <br />Laterel / <br />kU0026929 <br />Abutting Lot Line�=� g�0•� <br />N S E Vy��f:�; S.',O.UO h. <br />Approved By <br />iry Enyineer <br />Issued By_c�..� n.y��p <br />Inspection By �t�e/r„-,�„ <br />Datelnspected ��-z/-fi <br />INSi'C.QTIOid <br />rvo. 26929 <br />