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everett <br />e <br />City of Everett <br />�oSTE'G 2- ✓U <br />Sewer Application and Permit <br />N0. ?� C� � 3 DATE 1.�L� -�� <br />Service Address� ���^"" �' <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />ConnectionBy F yl�✓'P� <br />DESCRIPTION: <br />Plat <br />Unplatted D <br />" Type Permit: <br />Remarks: <br />Block <br />• \������ <br />� ���►� <br />IMPORTANT! <br />CALL 1 �8001324-5555 46-HOU RS <br />PRIOR TO DIGGING <br />CALL 259�6811 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Utility Account No. <br />Permit Fee <br />Connection Charge(s) <br />Total Fee <br />Signed <br />Customer <br />Sewer District <br />Monthly Sewer <br />Monthly Sewer Constr. <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />Ciry Engineer <br />I55112d BY���`� I �' `L� �+�� <br />� � <br />��� �� / <br />Inspection B� r� ✓'✓�v � -,ti -�' <br />Date I nspected � �� � �L � � <br />rvo. 2 6 � �; '3 <br />CliSTOiUI�R CO?Y <br />