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4 <br />� , .. , -,'�. <br /> � _� <br /> ( ';� <br />� =Y�' <br /> � � i <br /> CHART NO. i , <br /> everett <br /> C� -�- / ' � <br /> � � <br /> �_ ! , /_r, � _ )�_c� 's <br /> _ _` <br /> City of Everett <br /> � Sewrer Application and Permat <br /> N0. �Vv�� DATE ��nril .�� tn;:� _ <br /> Service Address�,T,� . � Utility Account No. <br /> Billing Address z�zz 100tL 5t. E� Permit Fee '+n_an <br /> City, State, Zip �erett, tcn 5@204 _ Connection Charge�s) ��� nn <br /> Owner (I, xtgagor) FC Construction Total Fee �n_on <br /> � Billing Name Same Special Gtility peo Ord. 1171-�15 <br /> i water 179.0� <br /> Connection By SII9e sexer 471.00 <br /> GSO.OD <br /> Address 5�e Signed ' <br /> CusL..ner <br /> Phone 33£1-0��5 <br /> DFSCRIPTION: Sewer District ���� <br /> Lot nn Block � <br /> Monthly Sewer Service <br /> Plat <br /> Unplatted Qescription Monthly Sewer Constr. <br /> �7Ji:?si�;u zi�F�,-,�;i� �;i)rFri�.r.:i t�; . , . � <br /> Trunk o�n nn <br /> Type Perr�ii: � <br /> Lateral %�UI:�10$C1+ <br /> v" _n :������;r.c.'.�— <br /> Rem arks: i1quQ26n tr; <br /> I — _ Abutting Lot Line,- ��-, i ;�i.Ul ' <br /> / L ,a.l�•t:l. <br /> �, v�, c� -s/✓ -: 7 �/r_ N, S, E, Wl:Jd'�rtiti, ; <-•n n�� ft. <br /> i / .zS� � .� � � � CcN� G�`�c�loJ`p� ��i.�'_�.l 9�ilU..�.�i} <br /> i:l)I iI.�J.4[�lri <br /> _ f1_GI:� 'fi,4`:i�.l)U <br /> I''t 151� '(5.`7.UU <br /> — APProved By " � s46d�,_,��4, � .'..��_ <br /> �Gi�N;...�'pineer . ,,.�Sj � <br /> IMPORTANTI L ';: (H :!'.i.id�� <br /> IIssued 8y r�+r,��, sue�'�dii�en <br /> CALL7-800�424-555548•HOURS � �.u_�.�; ���,g;.��;� <br /> PRIOR TO DIGGING <br /> � CALL 259-8611 FOR INSPECTION � <br /> Inspection By� <br /> Datelnspected__�� nc�+q <br /> SEE SKETCH ATTACHED NO. L`7V1� <br /> I:'.SP;:GTiO?: <br /> I <br /> i <br />