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. everett <br />L. <br />� <br />City of Everett <br />CHAHT NO.�'� `�� �` l f l <br />.� r <br />1 ��� j� <br />�_ - ,. .. c= <br />Sewer Application and Permit <br />No. 25975 DATE ��- Za "�J �� <br />_ <br />Service Address ? 1��� � � n� <br />Billing Address <br />City, State, 2ip <br />Owner (Mortgagor) <br />Billing Name — <br />Connection By � ' �' ` �� � �� �= r�' �� <br />DESCRIPTION: <br />.- Lot <br />Plat <br />Unplatted Descr <br />Per:nit: <br />\ <br />Utility Acceunt No. <br />Permit Fee <br />Connection Charge( <br />Total Fee <br />Signed <br />Cusromer <br />Sewer District <br />Block Monthly Sewer Service <br />Monthly Sewer Constr. <br />� <br />� � � P�`. ' :�o' �. < <br />AT /�c /�/ F7LL%�. <br />IMPORTANT! <br />CALL 1-800-024-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL259•8811 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />�Abutting Lot Line <br />" N, S, E, W <br />Approved By__ <br />� Ciry Engineer <br />Issued By.�� �, N � 1 � � � � <br />I nspection <br />Date Inspe <br />UTILITY BILLING <br />No. 26975 <br />� <br />