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� <br /> everett <br /> CHART N0. <br /> � � <br /> -��' Sc�ii To C�S�fi�.7idv �/..7_e� 8� <br /> t� <br /> � <br /> City of Everett ,_ � <br /> �` o <br /> w <br /> Sewer Ap��li�atiQrl cir�d Perrnit �r � . � �� <br /> u a -` •-� � <br /> ;= - n � -.� <br /> ' `�' � {,. � <br /> id0. Z�9�� DATE `^ � � '� <br /> _—,w.. .....c.vc^_ "=-,.v�-i; . <br /> Service Address_ 123:9 lbth D:. S,E. Utility Account No. � <br /> Billing Address_ =�e Permit Fee zn_pp <br /> City, State, Zi,�_ Evcrett, t�T 982p4 Connection Charge�s)_ �a0 0� <br /> Owner (Mortga9or)_ E.lmi;r 0, Wnrtha:^ Total Fee ap nn <br /> Billing Name_ sn�,,,. S�cial Uti].ity Fee, Orc. 1171-B5: $589.00 <br /> Cunnection By__ c+�,.*�,o,- � � 0„9 <br />,.� Address Signed '� <br /> Customer <br /> I Phone �3.7��� <br />� D'cSCRIPTION: SewerDistrict_prz -' �'r' <br /> Lot_ _ ESlock <br /> Plat Monthly Sewer Service <br /> Unplatted Description talonthl�• Sewer Constr. <br /> Type Permit: tdct+ Ca��r�ctio�; Trunk <br /> Lateral <br /> P,ema�ks: Pa±d 5j� LSLi 71J l:gru.me,-;t. Nc�?i <br /> Abutting Lot Line <br /> invoice Por side se»�r construction (siri;ed Lj N, S, E, W ft, ' <br /> le�,al a-�,�e�ty c4rner) Lie�c,re 11/'�ii�,,, ,�u: � <br /> Ce1ia Strc�ri� <br /> 3::iP. C�ci;az ,rit. i;�f"n�u !'. ittAL <br /> Everett, riA r'&2C: Approved By <br /> Ciry Enginccr <br /> IMPORTANT! ;i2t.i.�.'i., �. >!r.l_,,:.�i <br /> CALL 1-800-424•5555 48-HOURS Issued By_ � <br /> PRIOR TO DIGGING <br /> CALL 259�8811 FJR INSPECTION // ^ <br /> (f%�Inspection By _ <br /> Datelnspected � �2�� <br /> SEE SKETCH ATTACHED NQ GSg��, I <br /> � <br /> li�!>rE'�110i�J I <br /> — - -__ I <br />