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everetl <br />� <br />City of Everett <br />�� <br />Sewer Application and Permit <br />CHART N0. <br />S"<.rr ro cNs��r..�:.- ��27/a � <br />No. 25556 DATE �..�� �� � <br />Service Address��� �-'�2`���� Utility Account No. c� <br />Permit Fee_ � <br />Connection Charge�s) �N� <br />(- G� <br />Total Fee � <br />Billing Addnss <br />, <br />?f� , <br />City,: , =ip '; ; • _� I '' '�: <br />` <br />Owner (A'iortgagor►_% � <br />�.J <br />Billing Name � ' '' ' - <br />Connection <br />__�,.. <br />Signed ' <br />cu:tomer <br />DESCRIP ION: Sewer District --- <br />Lot BI •k _ <br />Plat ` Monthly Sewer Service <br />Unplatted Description � Monthly Sewer Constr. <br />Type Permit: <br />Remarks: <br />IMPORTANT! <br />CALL 1SOOd24b555 46•HOURS <br />PR�OR TO DIGGING <br />CALL 259�8811 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Abutting Lot Line <br />N, S, E, W, <br />i <br />Approved By � � <br />c�cr e�o��e� <br />Issued <br />Inspection By � <br />Date I nspected 3- 2-f 7 <br />I�SP�CTION <br />No. 25556 <br />