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IevereH <br />Ie <br />City of Eve►ett <br />Sewer Application and Permit <br />No. 25554 DATE <br />. ; ,_ <br />Service Address _ � � 1 <br />Billing Address • ' � - � _ � <br />City, State, Zip <br />Owner (AAortgagor) � � � <br />•..� <br />Billing Name <br />Connection <br />Phone � ' ' <br />CHART <br />ScNY TO CNL�Rf/NG <br />3 -17 -8 � <br />Utility Account No. <br />Permit Fee <br />Connection Ch��rge( <br />Total Fe� _ <br />":. �.i� <br />Signed �� <br />custonrer <br />DESCRIPTION: Sewer District —=--` <br />Lot `� Block Monthly Sewer Service <br />Plat � � <br />Unplatted Description � Monthly Sewer Constr. <br />Type Permit: <br />Remarks: <br />1 <br />IMPORTANT! <br />CALL 1-800d24•5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL259�88i1 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Abutting Lot Line <br />N, S, E, W <br />0 <br />,. � <br />� <br />Approved By � ' <br />Ciry Engineer <br />Issued By -- " <br />i <br />Inspection B���`'/���' <br />Date I nspected -� - � r- `6 <br />No. 25554 <br />INSP�CTION <br />