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everett <br />e <br />City of Everott <br />Sewer Application and Permit <br />N0. �`�vOO DATE J i is, �oe� <br />Service Address y�y _ �� � � <br />Billing Address fi�S foat� ifOth i103 <br />City, State, Zip T�pt, 11a�L�gtaq 9�033 <br />� r.NnaT Nn <br />Utility Account No. <br />Permit Fee y+_ne <br />Connection Charge�s)_ Z�p �p <br />Owner (Mortgagor) � Total <br />Billinc; P�a; ;e �� <br />Connection By s.Y <br />Address <br />lp�cial 1►M�, Ordlnano� 1171-56 <br />ib50.00 <br />Signed <br />Cu5[ORIlf <br />DESCRIPTION: Sewer District���u <br />Lot s Block <br />Plat —�1�� cr..� cl.e Monthly Sewer Service <br />Unplatted Description Monthly Sewer Constr. <br />Type Permit: � <br />Remarks: <br />S,KErr.f� sNaals <br />5/=' .�L. SK/ <br />IMPORTANT! <br />CALL 1-800�424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259�8811 FOR INSPECTION <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved By �A �*y <br />�kty �ineer <br />Issued By �+='9+z'�! E. 11cLwd <br />I nspection By iflG� C At C Fa.e <br />T.vs�'E�: io , <br />Date Inspected <br />No. 25600 <br />INSP6CTION <br />