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evereR <br />e <br />City of Everett <br />Sewer Application and <br />N0. Lv�o� DATE <br />�BrviCe Address s710 �...a aw <br />Billing Address +s�• n*+�+�s� <br />City, SWte, Zip u••utt � 9�01 <br />Owner (Mortgagor)�� r.....r.,...«�.... <br />Billing Name �-- <br />Connection By �ao� <br />Address <br />CHART <br />S Eiv: 7o c r�9c�� rtl � <br />/Z• s'-87 <br />Utility Account No. <br />Permit Fee 3p �� <br />Connection Charge(s) ��on�pt <br />Total Fee 30 00 <br />Special Otiliiy l�e, Ord. �fd 1171-eSi <br />vater a►lY 179.00 <br />I� ` ' <br />'-� <br />Signed `-` `_ '_—_� <br />Customer <br />Phone �SY �»i <br />OESCRIPTION: Sewer Distric: mnd zz <br />Lot_�� Block _ <br />Monthly Sewer Service <br />Plet t..ilverlh j(�11■ M� il <br />Unplatted Description Monthly Sewer Constr. <br />Type Permit: <br />Remarks: <br />IMPORTANTI <br />CALL 1�800324•5555 46-HOURS <br />PRIOR TO DIGGING <br />CALL 259�8877 FOR IYSPECTION <br />SEE SKETCH ATTACHED <br />Lateral <br />Abutting Lot Line <br />N, g, E, W ft. <br />Approved By u.roFn R_ r�?- <br />Ciry Enpinen <br />ISSUEd By Wma+r B_ Mei�xB <br />Inspection By <br />Date lnspected ,/�' � P� <br />N0. �v`O� <br />Ifd:'PECTIOV <br />