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C{iART <br />everett <br />� <br />City of Everett <br />7 � Pos-t �'�- <br />3--zv-��� <br />Sew�er ,Application and Permat <br />NO. ���`�" DATE Serjtemhnr ],� '��rr. L <br />Service Add�ess �gg�} g� g__. _ Utility Account No <br />Billing Address . <br />. ... � .. <br />City, State, Zip�� � <br />Owner (Mortgagor�_�y` <br />Billing Name <br />Connection By__ <br />Phone_�, <br />DESCRIPTION: <br />Lot l� B <br />Plat �raon Pl. <br />Unplatted Description_ <br />Type Permit: r.,AW �:,„r <br />Remarks: <br />IMPORTANT! <br />CALL 1-800-424�5555 48�HOURS <br />PRIOR TO DIGGING <br />CALL 259�8817 FOR INSPF.CTION <br />SEE SKETCH ATTACHED <br />Permit <br />Connection Charge(s) _ <br />Total Fee <br />Otilitv Oevelopment Fec Ord. 1171—E�5 <br />vater 179.00 <br />3ewer 471.00 <br />650.00 <br />Signed <br />Customer <br />Sewer District nonc? iu <br />Monthly Sewer <br />Monthly Sewer Constr. <br />�r; �- ;'_hii 1`�f'L4i�::'.'i'lil <br />Trunk `�izQ'_ nn'" • , . <br />lateral � i+liici�:;i", <br />,,.�„ , ,. _ , _. <br />t>tr,r, :•�,.a�; <br />Abutting Lot Linep�t�.�{ ;, �..;n <br />N, S, E, Wr�+r,,�;_��.� ft. <br />1. ti ;:li t 15, i1D <br />fil?I�IJ;' :�:':O.QO <br />;q0(10f�IlI;' <br />!.'i'Ilf'K' !:;it.!'�it <br />Approved By r�: �r : ,r <br />� <br />',.i n�. n cr:..:l:..l'!7 <br />!!11J1( I :� .�,U..liil <br />Issued By _ <br />�.'h;_i;i. 9:�;�, , .; II � <br />� / C��� <br />Inspection By , �/f <br />Date Inspected _ <br />No. 2ss3a <br />i: _. , ._ . , .;.� <br />