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evereri <br />e <br />City of Everett <br />s <br />�, <br />.� <br />� <br />,J <br />'.0 '�J V��L��.'Jy� <br />��5J i ei r�a r^: vi � <br />a• O� W y� K~+ �s <br />rA <br />Sewer Application and P�r.r�it =,�� r <br />W '�� C.7 V1J]? <br />cC �y ��S�m�,� <br />N0. 2vV�� DATE <br />�ervice Atldress _ <br />Billing Address 4749 7Lt !1 SK <br />City, State, Zip �ilteo, M!► 982?5 <br />Owner (Mortgagor) <br />Billing Name <br />Connection <br />Phone <br />DESCRIPTION: <br />Lot.�— Block_� <br />Plat _ <br />Unplatted Description <br />Type Permit: <br />Remarks: <br />IMPORTANT! <br />CALL 1-800-424•5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259�8811 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />CHART <br />j.,� �ln /'. ;,,/.. <br />Utility Account No. <br />Permit Fee . <br />Connection Charge(s) . <br />Total Fee_ <br />Ordinano� 117.'_-85 � <br />l- /3-89 <br />faias 179.D0 rater <br />�71..00 aaver <br />650., 00 <br />� . <br />Signed ' <br />Customer <br />� <br />; <br />Sewer District__ <br />Nior*hly Sewr: Service — <br />Monthly Sewer Constr. <br />Abutting Lot Line <br />N, S, E, W. <br />Approved By <br />„ . . • <br />Issued 8y Maraaret E Nciwod <br />� �.�� <br />Inspection By <br />K/ <br />d' <br />Date Inspected � r � <br />No. 26613 <br />I^:SPECTIOR <br />