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everen <br />e <br />City of Everett <br />Sewer <br />�� <br />s: <br />� <br />O J <br />'u. <br />�•. [a vs <br />� c•s �i <br />Application and Permi� .. °� � <br />��� �1 � C� <br />26082 �� � J � <br />N0. DATE ��ti a iqA� `' <br />Service Address yp�pt}� g� Utility Account <br />8illing Address g,er�.3�,; <br />City,State,2ip ��,;„�«e,, en,�s <br />Owner (Mortgagor) y�y�� Jnngara - <br />Billing Name �--- <br />Connection By �- • - <br />Address p q �� ��3 i4uF#�Eee 98Z73 <br />Phone <br />Permit Fee <br />CHART <br />�i.�'� �ii��`er.�, <br />C i p� G: �,� = <br />ar� �i i L':r J L� <br />aL-�i,-��i� ui�ji <br />±� w• ei� u5 .- r-. <br />a +n.� <br />y <br />T <br />� '� � �i is <br />� � � � M � � <br />�:���s.,�„ <br />Connection Charge� <br />Total Fee 30.00 <br />SpQcial Otility Fee, ord 11T1-35: <br />water 152.00 <br />aewar 400.00 <br />r 2.Q0 J <br />Signed �I <br />Cus;omer <br />DESCRIPTION: Sewer District ���nd <br />Lot +�..� y7 Block 828 <br />Monthly Sewer Servic= <br />Plat — <br />Unplatted Description � Monthly Sewer Constr. <br />Type Permit: <br />Remarks: <br />IMPORTANT! <br />CALL 1-SGO-024-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259•8811 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />T <br />Lateral <br />Abutting Lot L�ne <br />N, S, E, W <br />Approved By ��D R. Tt�'.AL <br />City Engineer <br />Issued By �4arat &. t�crwzod <br />Inspection By — <br />7- IS- �5' <br />Date Inspected �-�'�� <br />No. �sog2 <br />IivSPGCTIOM <br />