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everett <br />� <br />City of Everett <br />Sewer Applica�ion <br />Na. 26538 DATE <br />� <br />� <br />... � � <br />f 1 L7 <br />:: V� w <br />ti M <br />and Permi�, � <br />� ��� <br />*.�� •�, i000 <br />7!I L <br />Service Address���a , <br />Billing Address , , <br />City, State, Zip � <br />Owner (Mortgagor) <br />Billing Name <br />Connection By <br />Address . . <br />Phone <br />DESCRIPTION: <br />Lot y9 Block <br />Plat ��_ �� <br />Unplatted Description — <br />Type Permit: <br />Remarks: <br />IMPORTANT! <br />CALL 1-800�424•5555 48•HOURS <br />PRIOR TO DIGGING <br />CALL259A811FORINSPECTION <br />SEE SKETCH ATTACHED <br />GHART <br />� r - — <br />�1� � �;, �_;ri� <-. i , --_ .. - � � <br />� <br />53��� �5�� <br />Y. 4'1D �.7 d C.: <br />++s � ti � t 'f1 <br />� or. c: .i. f� � c- <br />s* e., .� <br />^Y � <br />� <br />�, � ,� <br />t�� :C Or�C�• � -.. <br />,��������,^� <br />�mw� 3 � :er��i-.'3 <br />Utility Account No. <br />Permit Fee <br />Connection Chargels) <br />Total Fee <br />Sp�clal Utility Tee Ord. 1171-85 <br />ML�r 179.00 <br />NM�S �i1.00 <br />650.00 � <br />Signed . �' '� • <br />Cuslomer <br />Sewer District """a Tr <br />Monthly Sewer Service — <br />Monthly Sewer Constr. <br />Trunk z'fn n� <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved By r�rn R THFf1T <br />City Enpineer <br />Issued By �Ly F- r <br />Inspection By�� ' <br />Datelnspected ` 2� �� � <br />No. 26538 <br />INSPECTION <br />