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everelt <br />e <br />City of Everett <br />Sewer Application and Permit <br />CHART NO. <br />S'Eni.— Ta ch'•o,e %.a� <br />3 ��_�� <br />No. 25691 DATE �� �� �� � <br />Service Address i 151� - SLt al s11 Utility Account No. <br />Billing Address_� <br />City, State, Zip �...��� _ r� ��e,u <br />Owner (Mortgagor) r�..�.,,, n.,.,....,...i,.. _ r..,_ <br />8illing Name �.�. <br />Connection By s.�. <br />Phone �y ��� <br />DESCRIPTION: <br />Lot_____;T.__ Block <br />P�Bt w�lerr Cr�i Gl�n <br />Unplatted Description <br />Type Permit: <br />Remarks: <br />F'� <br />IMPORTANT! <br />CALL 1�800�24•5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-6871 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Permit Fee 30 DO _ <br />Connection Charge( <br />Total Fee �p pp <br />Sp�alal fN. or� 117�SIXJORi�.i77 tTl'S <br />�ral�z anlp 001 ° <br />ft(]W 163i4 <br />Signed i I';. 6 SnY.I{ / t1.5D <br />— c�.io" fi�rl�—'SIS�— <br />Ea.re sza�.00 <br />� Lf�i i�4.00 <br />Sewer District �� ;lo,�p <br />Monthly Sewer Ser� �R �'� <br />�- <br />_ Monthly Sewer Cor��r.1-5 ��=^'•4.W <br />i.r+eCl; �h�.W <br />Abuttir�g Lot Line <br />N, S, E, W <br />Approved By 1�iiRED R• S1�iL <br />Ciry En9ineer <br />Issued By M�selas+t E. McLod <br />i <br />Inspection �� <br />Date Inspected_ 3—L �% <br />I�SPECTIOid <br />No. 25691 <br />