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everett <br />e <br />City of Everett <br />Sewer Application and Permit <br />CHART NO. <br />� e.n�i ta p> s�!� "°) <br />,_1��, <br />N0. L���L DATE �u.9 looe L_ <br />Service Address i�� se� st Utility Account No. <br />Billing Address_ 1�6 - +�h �1M • <br />City, State, Zip "-----'. �► o��o� _ <br />Owner (Mortgagor) �*���* �d <br />Billing Name - <br />Coniiection By <br />DESCRIPTION: <br />Lot Block <br />Plat <br />Permit Fee �w— <br />Connection Charge(s) <br />Total Fee <br />Q[d'uuao� 1171-eS <br />wt�r 17�3M�!'70 10:30AM OOOAl114;K. tttl <br />...�.: �n.00 i <br />6S '4151 �' � <br />Signed W.�i t473.��� <br />c fa .OD <br />ifECN i90.40 <br />Q SkCll f�i.50 <br />Sewer District "���� <br />MfiiF7: 560.00 <br />Monthly Sewer Servfii� s� � <br />GQOOt2773.." <br />U�platted Description Monthly Sewer Conl�71-S lE;�0.00 <br />MW033fliQ <br />Trunk f�F'1AR' 45Q T� <br />Typa Permit: CIIECK fltiO3.25 <br />Lateral <br />Hemarks: <br />IMPORTANTI <br />CALL 1500�424•5555 48•HOURS <br />PRIOR TO DIGGING <br />CALL 759�8811�fOR �'��SPECTION <br />SEE SKETCH ATTACHED <br />Abutting Lot Line <br />N, S, E, W <br />Approvecl By �� Q""Y'�" <br />ciry Enpineer <br />Issued By J 1Exlcv�ll <br />Inspection By `�`,� <br />Date I nspecied jO �' So <br />If�lcnLCT10�; <br />No. 2T732 <br />