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CHART N0. —. <br /> everetl <br /> � . <br /> c,� .��i` r��'J ' l ��('/�� <br /> � <br /> City of Everett <br /> Sewer Application and Permit <br /> N0. �v�L� DATE � � *- 36 19Q� <br /> Service Address_ SIl! s���i.r rar Utility Account No. <br /> Billing Addras ■��� Permit Fee ;p.,�� - <br /> City,State, Zip t��r��� . ri o�2n+ Connection Chargels) •*.��� 7�0 00 <br /> Ovmer (Mortgagor) ai��. or.s. Total Fee +n �n - <br /> Billing Name a� _ Bpecial Otiltt� i�• OrA. 1171-�5 <br /> vat�z t2�.00 <br /> Connection Bv ■� or�ea t��i ��itt <br /> .•�.r s�s.00 <br /> Address +sia lesrd •i ■z =....ec Signed Y1�.0Q ' <br /> cusromer <br /> Phone 13' 411' <br /> �ESCR�PTION: Sewer District ��A� �� <br /> lot o B��k � Monthly Sewer Service <br /> Pl�t a���i�r �a�iyst■ <br /> Unplatted Description_ Mo�thlr'Sewer Co�str. <br /> Trunk �70.00 <br /> Type Permit: M�� Coes�etion =� �N,�.1� �t <br /> Lateral SU.��7003 <br /> Remarks: Abutting Lot Linet�� <br /> WAiFR €75�i.U0 <br /> N, S, E, W��_.--n� <br /> S1:WfF f30.1i11 <br /> — F�U 11. 67:.Y1.t70 <br /> J171-, GH13.00 <br /> iN)Gill ti8f15 <br /> Approved By�;M���5----- <br /> PCRY3 �0� �540.00 <br /> IMPORTANTI �G{ i4b.50 <br /> Issued By <br /> CALL 1800424-5555 48-HOURS (� �'J`a{ i3.5U <br /> PRIOR TO DIGGING G SF.C11 SIS.[�U <br /> CALL 259-8811 FOR INSPECTION �:t ' �`0•� <br /> 4,1� <br /> Inspection By <br /> Date lnspected 3�d� <br /> SEE SKETCH ATTACHED N0. 264Z1 <br /> I i�:SPCCTIO?1 <br />