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CHART N0._ <br /> evereh • ' <br /> e <br /> City ot Everett �".�T To C,�;qi;�,�i.,= // �?�,; <br /> I <br /> Sewer Applicafion and Permit <br /> N0. 2�$`�� DATE Ortnhn� 6 144f, <br /> Service Address 12(1�1 4f}y� t ath nr cc Utility Account No. <br /> Billing Address <br /> 7541 104 D1 CF Permit Fee �n nn <br /> aa „n aQ�Q4 Connection Charge�s) �'+� nn^_ . _ <br /> �: : <br /> City,State, Zip ' " ' ' ' '�T <br /> pwner (Mortgagor) Ri� (lanne _ Total Fee �u����-- I <br /> Special Utility Fee��f�diaeriae>'11�1-85 <br /> Billing Name �amp water 174.0 0 �'�-��!' P°��.D U <br /> sewer 471.00 ��E�-�� �:9�00 <br /> Connection By cama — 650.Q0 t� SF'C!1 •�l.`.�r� <br /> G '�t�:CH :15.OU <br /> Address Signed c� � <br /> :ti . <br /> ;i011iYiS�i 5 <br /> Phone �Z7 ��1Q biiilE4' x-hU•IT� <br /> Sewer District R��?���`f��'r'� <br /> DESCRIPT!ON: ��' =" ' A� I <br /> Lot Block }�_ <br /> � Monthly Sewer Serv @`'i� ''='�'�C I <br /> li i l-'.i Y�rSU.(i� <br /> Plat_ I:P 578,_0.(A] <br /> Unplatted Description Monthly Sewer Cons�t� <br /> - Trunk <br /> Type Permit: <br /> Lateral <br /> Remarks: '- � � �" <br /> Abutting Lot Line <br /> I N, g, E, W ft. <br /> ����uv <br /> �✓',GS ��� n <br /> I 3 0 3 �', s � <br /> Approved By n� cacn n 7��Fp� <br /> Cny Engineer <br /> IMPORTANT! <br /> ISSued By darnn�at C 11r1 rpA <br /> CALL 1-800-424�5555 46�HOURS _ <br /> PRIOR TO DIGGING <br /> CALL 259-8811 FOR INSPECTION � <br /> Inspection By <br /> Date Inspected <br /> �� �`� ( �N� ����D <br /> SEE SKETCH ATTACHED <br /> li��°;CTI(��ti' <br />