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everett <br />e <br />City of Everott <br />Sewer <br />�. <br />� ���� <br />x 8 g$ �gs.� <br />� � �� ������� <br />w <br />� � <br />� Per 't " <br />Applicc�i � �r� � z�!� � <br />� ������������ <br />CHART NO.__ <br />N0. <br />ZTH.ris `� DATE '–'– "' 1O°° <br />Service Address Utility Account No. <br />/ � =0� 22� Permit Fee <br />Billing Address � ' <br />City. State, <br />Owner (Mortgagorl��]= s +��"`t <br />Billing Name <br />Connection <br />DESCRIPTION: <br />lot Block <br />`ro ��' `"`� <br />�Z -z8� <br />Connection Chargels) '"–" — <br />Total Fee <br />ay;�es 1171–l5 <br />ralar 179.00 <br />�= 471.00 <br />650.00 <br />Signed � ` ,', . ; � <br />cuitomer <br />$CWCf �IStfICt <br />Monthly Sewer <br />Plat <br />Unplatted Description Monthly Sewer Constr. <br />Permit: <br />Remarks: <br />IMPORTANT! <br />�qL� 1.SOOd24•555548-HOURS <br />pRIOR TO DIGGING <br />CALL 259�811 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Abutting Lot Line <br />N, S, E, W, <br />Approved By ry na.n� <br />Issued BY <br />Inspection By ' "`" � <br />Date Inspected /�'�� f'D <br />No. 27856 <br />INSPECTION <br />