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evereft <br />�e <br />City of Everett <br />r sa <br />N Q D <br />rl �1 rf <br />N <br />ram. <br />Sewer Application and Permit <br />NO. 26895 DATE <br />Service Address 7fi2 +talon Ala+• — <br />Billing Address=�+s -- <br />City, State, Zip <br />Owner (Mortgagor) pie uxicA — <br />Billing Name_ <br />Connection By— <br />Address— <br />Phone — <br />DESCRIPTION: <br />Lot <br />Plat <br />Unplatted Descr <br />Tvne Permit: <br />Block <br />Remarks: <br />el'e <br />n. Gf d <br />IMPORTANT! <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8811 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />CHART NO. <br />5i't&6&'4, 7' /0-ly-3B <br />Utility Account N <br />Permit Fee 10.00 <br />Connection <br />Total Fee <br />Signed <br />Customer <br />Sewer <br />Monthly Sewer <br />Monthly Sewer Constr. <br />Abutting Lot Line <br />N, S, E, W, <br />Approved By <br />iry ngineer <br />Issued w tWOW <br />Inspection By ' — — <br />Date Inspected <br />NO. 26895 <br />INSPECTION <br />