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everert <br />.. <br />� <br />City of Everett <br />Sew�er �,pplic�tion aro�l Perrrait <br />N0. 25;�1� DATE /i�L/ /' .� S� — <br />/i- �,� -s <br />Service Address ✓��r ��% �� ''��' Utility Account No. <br />%f� i ,;�/ <br />BillingAddress ����� ,�"`{�� SE Permit Fee .^'G <br />City, State, Lip�'P/�-� u✓� /��O�Connection Charge�s) <br />� dL�-- <br />Owner (Mortgagorl ��G�E ��Gt` Tota� Fee '/1� <br />Billing Name <br />Connection By�`���i�'�� <br />✓ <br />Address ' <br />Phone � �- � S `�.Z— <br />DESCRIPTION: <br />Lot <br />Plat __ <br />Unplatted Uescr <br />j Type Permit: <br />Remarks: <br />Block <br />IMPORTANT! <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL259-88',7 FOR INSPECTION <br />SEESKETCH ATTACHED <br />Signed - 1 � " : � <br />' Cuswmer <br />Sewer <br />Monthly Sewer Servi <br />Monthly Sewer Constr. <br />Lateral <br />Abutting Lot �ine <br />N, S, E, W <br />v . <br />Approved By <br />Cily En9ineer <br />Issued Bv <br />Inspection By—�' "" ' <br />Date I nspecCed �� ���� <br />I(JSFLCTICi��! <br />No. 2531b <br />