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everett <br />� <br />City of Everett <br />Sewer Application and Permit <br />CHART <br />��,�,t�U ��r�2-���, 5�2Z�� y <br />No. 26643 DATE �F1ril �ty toaA � <br />Service Address 1915 xt8 ;Stl� �t, sP. _ Utility Account No. <br />Billing Address 17908 7dth Ava. X. <br />City, State, Zip Sdaonda. Wa 98020 <br />Os+mer (Mortgagor) Vircrinia_��nrd <br />Billing Name s�e <br />Connection By same <br />Address_.. � <br />Phone 7aa-a�se <br />DESCRIPTION: <br />Lot g_ Block } — <br />Plat y�.r���gbt,a <br />Unplatted Description <br />Type Permit: <br />Remarks: <br />IMPORTANT! <br />CALL 1�800-424-5555 48•HOURS <br />PRIOR TO DIGGING <br />CALL259•8811 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Permit <br />Connection Charge(s) �+�a <br />Total <br />Special Utility Pee Ord <br />vater 261.00 <br />aever 688.00 <br />949.00 <br />Signed_ <br />Sewer District *--a * <br />1171-SS <br />Monthly Sewer Service <br />f�i:'i�iis�; L:lil'n I1riCo'r;iii;���b �ti�i <br />Monthly Sewer Constr. , <br />t�Of�K?Ea43 <br />Trunk �•������ � y <br />�-�. ::8.fl <br />il?.t= : 5�949.fi(t <br />La tera I _�;,yy;i,w�r,^ <br />69.(?ti sf..�_.C�il <br />Abutting Lot LineSi_I.:G :`.�J.f�.� <br />N, S, E, WhEcN :�;>t.!�Ii ft. <br />F9Jl t;N Y�S.'7 <br />i; ;;iit:H �'�.`dJ <br />f..`.iF`L;N i15.f.di <br />ur:��+a,� ::�a.a� <br />Approved By . . "',-"'= <br />. lii�. .ngineef i �Ij.LC.i <br />r'.�� ,�c:�. <br />CHclr, i�..�ro.Ut <br />Issued By �.� ��•�y� <br />Inspection � � _ <br />Date I nspected 3 a� - <br />No. 26643 <br />in��r_criorv <br />