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evereft <br />e <br />City of Everett <br />Sewer Application and Permit <br />CHART <br />`t ti�T To L,��.e r...ic- <br />!�-�d <br />No. 25669 DATE `� Z- x� L <br />Service Address ���� i/ro n 1,���il� �1,�4�y Account No. <br />Billing Address Permit Fee �k•%��/�3� `' 9:a�ifiil OIli1Fl4AiU2 i kSt <br />City, State, Zip Connectiun Charge�s) �i.UCii, 's1�t.(� <br />CIk:G; ,.� ^1� <br />Owner �Mortgagor) I � Total Fee % <br />Billing <br />Connection <br />t <br />Phone <br />_ .. . /' �.... __.. <br />,� !,i <br />_ Signed <br />Customer <br />DESCRIPTION: Sewer District <br />Lot Block <br />'Plat Monthly Sewer Service <br />Unplatted Description Monthly Sewer Constr. <br />CALL 1-600-024-555546•HOURS <br />PRIOR TO DIGGING <br />CALL 259-8811 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Abutting Lot Linc <br />N, S, E, W <br />Approved By <br />Ciry Eneineer <br />Issued By - _ <br />` <br />�_�� <br />Inspectian Bv_.�-�� <br />Date Inspected G ' Y �`+'� <br />No. 25669 <br />I?;:PGCTICie <br />