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CHART N0. G ?U— �9'S <br />everett <br />e <br />City of Everett <br />Sewer Application and Permit <br />` No. 26973 DATE �� ��� -G�� �— <br />Seniice Address ��� I�: ? j � Utility AccounY No. <br />Billing <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Connecticn By �- 1��1 C� 1 1=-UE:.I''� �t <br />DESCRIPTION: <br />Lot_ <br />Plat <br />Unplatted Descr <br />Type Permit: <br />Remarks: <br />�,, i� <br />fIN� �l <br />�Q ,. � �� . <br />� n �t � ; <br />y3 ' <br />Block <br />I (a' o� /S'iri,4 <br />: <br />�/� c � X. i� <br />Q c.�./C� Y T'o �� <br />I <br />��� <br />i-, D . i <br />� f /%�h � �� <br />IMPORTANT! <br />CA L L 1�800-024-5555 48-HOU R S <br />PRIOR TO DIGGING <br />CALL259-8617 FOR INSPEC710N <br />SEESKETCH ATTACHED <br />Permit Fee <br />Connection Charge( <br />Total Fee <br />�� � �-.-z-,� � <br />��-2o-B9 <br />Signed <br />cu:tomer <br />, ' ; <br />SeH�er District_ <br />Monthly Sewer Service. <br />_�Monthly Sewer: Cpnstr. <br />, <br />�'�. ( . - � . . <br />�Abutting Lot Line <br />N, S, E, W <br />Approved E3y <br />Ci:y Engineer <br />Issued By�L`, 1 � � ' � `. Y <br />/ � <br />Inspection E •� <br />Date Inspected � ( � � 5 " � / <br />No. 26973 <br />UTIi_I i 1'' BILI_li�!G� <br />� <br />