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vere� <br />� <br />City of Everett <br />Sedver Application and Permit <br />CHART <br />v,:��T �� ��/i� _i�.% <br />N0. GJ3�`� DA7E J� I— <br />Service Address��� �� �_L�� ��� Utility Account No. <br />Biiung Address. <br />City, State, Zip <br />Owner (Mortga <br />Billing Name_ <br />Connection By. <br />Phone <br />a <br />Permit <br />Connection Chargels) <br />Total <br />; �� <br />s <br />, <br />,� <br />��,.�. .����, <br />� . �� <br />Signed ' �' ` <br />Customer <br />DESCRIPTION: Sewer District <br />Lat —, Block MonthlySewerService. <br />Plat � <br />Unplatted Description Monthly Se�ver Constr. <br />Type Permit: <br />Remarks <br />IMPORTANT! <br />CALL 1-800-424-5555 48•HOURS <br />PRIOR TO DIGGING <br />CALL 259•8811 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Abutting Lot Line <br />N, S, E, !0.' <br />Approved By <br />City Enginccr <br />Issued By � �— <br />� <br />Inspection By � <br />Date I nspected Z' � � <br />No. 25385 <br />INSPECiIOf� <br />