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CHART <br />everetl <br />0 <br />City of Everett <br />Sewer Application and Permit <br />S�E.tli To C9647A4 / 197 <br />NO. 25873 DATEL— <br />utility Account No. <br />Service Address <br />Permit Fee----.t-4 <br />Billing Address <br />Connection Chargel <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Connection <br />Phone <br />DESCRIPTION: <br />LotBlocky---- <br />Plat <br />Unplatted Description <br />Type Permit: <br />Remarks: <br />IMPORTANT! <br />CALL 1,800.424-555548-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8811 FOR INSPECTION <br />Total Fee <br />tur#mt Liq <br />Signed IDi 11ia" <br />Customer . <br />r <br />f!QU01',TY9 <br />Sewer District <br />iittixk i. <br />Monthly Sewer Ser ' _ . <br />I�Itii41 }4•IICI <br />Monthly Sewer Constr. <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved BY <br />ntv r <br />Issued BY , <br />Inspection B � �`4cc <br />Date Inspected <br />No. 25873 <br />SEE SKETCH ATTACHED <br />INSPECTION <br />