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everett <br />� <br />City of Everett <br />Sewer Application c�nd Permit <br />No. 25546 DATE � <br />Service Address � � ��- Utility Account <br />1 , �.� ; -' .: -/. ; /.�' , j; <br />Billing Address �--' <br />City, State, Zip '�. . � � �,�: i `, t�. J <br />Owner �Mortgagor) '� � <br />_. �� <br />Billing Name - <br />Connection <br />:�_ / �. � . -'^ �% � <br />CHART N0. <br />i .... - � ! `� <br />SC.�IT Tc CH.?<?in/C• .3/:�1 �8% <br />Permit Fee ._�L--=L <br />A iy/] <br />�_�:- �� <br />�. Connection Charge�s) ' _ � <br />Total Fee '6 ) �� � <br />b <br />. - �---�- <br />. ,' ;' j i! � ..> .: .-�=c— <br />�' 1 <br />Signed <br />customer <br />_,/�. <br />DESCRIPTION: Sewer District �� — <br />Lot Blocb <br />Plat ! �'_�'�p�y{�. Monthly Sewer Service <br />Unplatted Description —�v Monthly Sewer Constr. <br />Type Permit: <br />Remarks: <br />IMPORTANT! <br />CALL 1-600-024•5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 2595811 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />7 ;;; '.'_. <br />City Enyineer <br />ISSIIE(� BY "_ ' � r-' ' � <br />Inspection B' i <br />Date Inspected ' � �� <br />No. 25546 <br />I�dSP6CTi0t� <br />