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everett <br />e <br />City of Everett <br />S�wer Application and Permit <br />CHAR7 N0. — <br />SE:✓T To CH�+.2T•,rrv �/S/97 <br />No. 25693 DATE �. 19A6 � <br />Service Address Utility Account No. <br />Billing Address�� <br />City, State, Zip �,�������,�— <br />Owner (Mortgagor►� <br />Billing Name �_ <br />Connection By __ <br />Phone <br />DESCRIPTION: <br />Permit Fee 30 �� <br />Connection Chargels) �_ <br />Total Fee an nn <br />s��.� saMe� F� ore. 1171-s5 <br />w.t� s;z.�o <br />/ . <br />' i <br />' �'��1�::;� � � <br />Signed— <br />cu:tomer <br />Sewer District �p�j� <br />Lot�— Block <br />Plat y�1rr f'p�k �� MonthlySewerService <br />Unplatted Description Monthly Sewer Constr. <br />Type Permit: <br />Remarks: <br />IMPORTANTI <br />CALL 1�00�24-5555 48•HOURS <br />PRIOR TO DIGGING <br />CALL 259-8811 FOR INSPECTION <br />SEE SKETCH AT7ACHED <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved By�L <br />c�iv �u� � <br />Issued By ������ <br />Inspection By ��� <br />Date I nspected /�� 3 ' �� <br />INSP[CTION <br />No. 25693 <br />