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evered <br />� <br />City of Everott <br />Sewer Application anc� Permit <br />r:�. 25618 <br />Service Addreu_ <br />Billing Address�' <br />DATE <br />��D .Y � `" i _� .�- <br />City, State, Zip � / �. <br />>;, � f � : .._�,,` <br />OMmer (Mortgagor) ! <br />Billing Name � � � ' '--='f <br />Connection <br />, .. <br />.,-, . �,, <br />Phone <br />DESCRIPTI <br />Lot �k <br />Plat � — <br />Unplatted Description - <br />Typa Pertnit: <br />Remarks: <br />IMPORTANTI <br />CALL 1�800d24-5555 48•HOURS <br />PRIOR TO DIGGING <br />CALL259$811FORINSPECTION <br />SEE SKETCH ATTACHED <br />CHART N0. <br />,Sc`aJT 7o CH.9,�'i/.,'G �.�87 <br />+�z�;e� i=�� oo�aro�o ua <br />/ N000163Sd <br />Utility Account No. o �+ �� � <br />,�}�gCy.�- t15.00 <br />Permit Fee > n m }2p3 ti(i <br />PI.EG S2D.Q0 <br />Connection Charge(s) -� <br />pRW1!-'-- tr.^0.00 <br />Total Fee - �.IEU � i70 tM2 <br />: ! l % - > . `� 112i-S" , �f�?4.fl0.: / --� <br />MATkR t60.00 <br />1aECy; #676.00 <br />Signed � c��om�. <br />_-----'�_ <br />�/ <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />: <br />-. � <br />Approved By ( iT i,. - <br />c��v e�,u��ex <br />Issued By �-- - ` <br />Inspection B/��� <br />Date I nspected �� � �- &� <br />No. 25618 <br />INSP6CTION <br />