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evereft <br />� <br />City of Everett <br />w <br />� <br />� ����R�u' <br />" c� r= o r� .� <br />O 17�0� M� <br />-0 <br />r> � a� <br />Sewer Applicatio� and P�r�it ���, <br />No. 26273 <br />Service Address <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Connection By_—� <br />Address��o <br />Phone <br />DESCRIPTION: <br />Loi ��–�s Block <br />Plat <br />Unplatted Description <br />Type Permit: <br />Remarks: <br />� ����x�� <br />,� ����''`z�ow <br />DATE �Iu7��1Gr.19�87 <br />IMPORTANT! <br />CALL 1500�424-5555 48•HOURS <br />PRIOR TO DIGGING <br />CALL 259-8811 FOR INSPECTION <br />SEE SKETCH 4TTACHED <br />CHART <br />�e.,.,��� C'r�w,�'...�, � i� SG <br />S3 �S`6 <br />n l'd O L^1 <br />a. .�. oi r� <br />M � � •w <br />� � � � � � <br />M <br />2C ' � _. V <br />Utility Account No. <br />Permit Fee 30 00 <br />Connection Charge(s) �*r <br />Total Fee 30 00 <br />Speclal Otilit� !e� Ozd. 1171–BS <br />vatar 160.00 � <br />��wr 1212.00 <br />1672.00 <br />Signed _ _ __ <br />Sewer D <br />Monthly Sewer Service — <br />Monthly Sewer Constr. <br />Trunk <br />Lateral <br />Abutting Lot Line <br />N, S, E, W ft. <br />Approved By 1f='!IIT n Twe.• <br />Ci1V Engineer <br />Issued By <br />� / <br />Inspection By ! ����" <br />Date Inspected �^ � ��� <br />No. 26273 <br />INSPECTIOPJ <br />y <br />. <br />