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CHART NO. <br /> everett <br /> e "cN.- T� �„��:...� .�,,,s� <br /> ,Pcc..oG i��/�� ttu Asa��t�. <br /> City of Everett <br /> Sewer Application and Permit <br /> No. 25379 DATE �Z' � � - � � <br /> Service Address� I f`J'�� ,_rn��`� ���""' Utility Account No. <br /> , /' � <br /> Billing Address � '� `- � Permit Fee ��?—� <br /> � � <br /> City,State, Zip �- �%'��'�t� �v ' �''' �� �1T � ConnectionChargels) <br /> Owner �Mortgagor) ` - " '� ' ,% '�� ' ���'� ��" " -'TotalFee � ' <br /> BillingName - - `" . j'�;'h,;_ ._ ;, . r� ,. � _ , <br /> j - / :1 - �_" . , �� <br /> Connection By � <br /> , � , <br /> Address r � � <• �i (i >' / , , . .. ; ,�;.:'� Signed t_ <br /> - Customer <br /> Phone � / � / ' � l� � <br /> DESCRIPTlON: Sewer District <br /> Lot � �- Block <br /> Plat ��fF t-�' �/�VE��E �ieD�/l'% Monthly Sewer Service <br /> Unplatted Description Monthly Sewer Constr. <br /> N � Trunk <br /> Type Permit: <br /> Lateral <br /> Remarks: <br /> Abutting L.ot Line <br /> �� -�,��,,,,� eQ,� S�1Qi�i N, S, E, W ft. <br /> — Approved By � : ��'i " `�' <br /> City EnBineer <br /> IMPORTANT! <br /> Issued By �- %r•" , - — <br /> CALL 1-800-024-5555 46-HOURS . / <br /> PRIOR TO DIGGING � <br /> CALL 259�817 FOR INSPECTION � ' <br /> Inspection By � <br /> Date Inspected 5`�&-' <br /> SEE SKETCH ATTACHED No. 25379 <br /> I�!SPEC(IOf�J <br />