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everett <br />e <br />City of Everett <br />Sewer Application and Permit <br />No. 264C19 <br />DATE � l - `I - �� <br />Service Address� � 5 y' q�. S� S r✓ <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Connection By %�'��� Dr E/JGY'��"�' <br />DESCRIPTION: <br />Lot <br />Plat __ <br />Unplatted Descr <br />Type Permit: <br />Remarks: Q <br />tv�a � rL � <br />,,�,...,�e� <br />CHART NO. �• � � � <br />�/8� PosrED+TurnMS ��� <br />Utility Account No. <br />Permit Fee <br />Connection Chargels) <br />Total <br />Signed <br />Customer <br />Sewer District <br />Block <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />�. PVc <br />�F� PVc <br />n �-- r <br />� �.. - . �. �. <br />L �'.� <br />jp�' ,S, a% �`-� <br />IMPORTANT! <br />CALL 1-800-424-5555 48•HOURS <br />PRIOR TO DIGGING <br />CALL 259-8811 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />) Approved By <br />�%fi . CitV Enpineer <br />Issued By ��1����� �' <br />Inspection By -���— <br />Date Inspected ��— � — g� — <br />N0. � ��4!J'� <br />CUS I'CfdlGfi CO?1' <br />