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everett <br />e <br />City of Everett <br />Sewer Application and Pern�it <br />No. 25543 DATE Ir.r1� �G� taie6 <br />Service Address }SBi�-i�3t--Iti-Sy — Utility Account <br />Bil;ing Address <br />City, State, Zip_Sa���l1}-MII-Ow',=-- <br />Owner (Mortgagor) <br />Billing Name_�� <br />Connection By_,_�� <br />Address <br />Phone <br />CHAR� N0. <br />,SC'NT 7a L JYA,QTi.tJG �, /s/A7 <br />Permit Fee— .�„ <br />Connection Chargels) MOAa <br />Total Fee 30.00 <br />Ord. 1171-85 Mater22�.00 <br />Signed._�" ��� ` � <br />ca:rome. <br />DESCRIPTION: Sewer Distri�t—. __ <br />Lot � g�ock ou�w — <br />Plat �1�1011 (.1Ylk G1ln Monthly Sewe: Service <br />Unplatted Description Monthly Sewer Constr. <br />Permit: <br />Remarks: <br />IMPORTANTI <br />CALL 1-BOO�i24•5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8811 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Latera <br />Abutting Lot Line <br />N, S, E, W, <br />Approved By <br />E <br />Issued By <br />Inspection By � �R�P/jyJ�j7 <br />Date i nspected [v - Z- ' �E� <br />INSPECTION <br />No. 25543 <br />