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everett <br />e <br />City of Everett <br />CHART NO.y J�- <br />M 29 - <br />L'O-TAD <br />12 -ZI-8� <br />Sewer Application and Permit <br />NO. 2�6969 DATE <br />Service Address <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name__ <br />Connection BY n ! <br />O S 'J - i'E ? 'T <br />DE-CRIPTION: <br />Lot <br />Plat <br />Unplatted Descr <br />I <br />Utility Account No. <br />Permit Fee <br />Connection Charge(s) <br />Total Fee <br />Signed Cnslnmei <br />Sewer District <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />3y3a <br />a• '> Mo <br />Remarks: <br />CAC-R / 2n^ <br />3 <br />3 <br />A a <br />lte<- iohs 'v" <br />,4113 <br />G� IyW IMPORTANT! <br />r� <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL259-8811 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />4butting Lot Line <br />N,S,E,W <br />Approved By <br />City Engineer <br />Issued By—D N MdLZ <br />Inspection <br />Datelnspe <br />CUSTOMER COPY <br />No. 26969 <br />