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CHART N0. — <br /> everett <br /> � S��c�: To C/f'�P�7i.c'G <br /> �-/,��- 9b <br /> City of Everett <br /> Sewer Application and P�rmit <br /> NO. Z��J� DATE �th�e 7QRh <br /> Service Address _ Utility Account No. <br /> Billing Address��� Permit Fee _ <br /> City, State, Zip , Connect�n Charge�s) 3�8.��— <br /> . � <br /> Owner (Mortgagor) Total Fee . <br /> Sewer Development Fee Ord. 1161-85 <br /> Billing Name SSte1' 179.00 <br /> Sexer 471 .00 <br /> Connection By — ' .550.00 <br /> , i. <br /> Address Signed ' ' • _% �.=`'t %� %" <br /> Cusmmer / <br /> Phone <br /> DESCRIPTION: Sewer District <br /> Lot }q Block Monthly Sewer Service <br /> Plat�� <br /> Unplatted Descrip''on Monthly Sewer �onstr. <br /> _ Trunk <br /> Type Permit: ��Rt cftnneCYion <br /> Lateral <br /> Remarks: Abutting Lot Line <br /> N, S, E, W_ ft. <br /> Approved By <br /> t Enqi <br /> IMPORTANT! <br /> Issued By <br /> CALL 1-800-024�5555 48-HGURS � <br /> PRIOR TO DIGGING <br /> CALL 259•8817 FOR INSPECTION � <br /> Inspection By �' � <br /> Date Inspected �<<`y ���' 6 <br /> SEE SKETCH ATTACHED No. 25494 <br /> li�!S?��C'i�OP; <br />