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�:;; <br />� <br />�_ <br />everett <br />� <br />City of Everett <br />Sev�er Applieati�n and l�ermot <br />rvo. 26391 <br />DATE � '3"g� <br />Service Address_ '� � � � ��� � %� �F� � `S� - <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Connection 8y C I i� �/ ��� r L_ v�-.r: .1" "h <br />Address <br />DESCRIPTION: <br />Lot <br />Piat <br />Unplatted Descr <br />���I�U <br />I� � � � Z <br />�� � - <br />�, <br />,� ,; <br />� <br />Utility Account No. ��l 5- ! �� ' t <br />Permit Fee <br />Connection Charge(s) — <br />Total <br />Signed <br />Cus[omer <br />Sewer District <br />Block <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />Type Permit: �..t �, �, Fj <br />Remarks: .; �� � � ' <br />�;�n � e��� 5��� <br />ii �„ n.... c- <br />� c� `� ' L . � o/ /1'a N � �t/ /-��.0 ` <br />� lMFORTANT! <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8811 FOR INSPECTION <br />SEESKETCH ATTACHED <br />G� <br />� <br />Abut[ing Lot Line <br />N, S, E, W <br />Approved By <br />City Engincer <br />Issued By 1)<:; n� �VI ! � � �'- Y' <br />i / / I <br />Inspection By � � '�� ��� i <br />Date Inspected u�' `'�" ��� I <br />No.2s3s:� �I <br />,-, , ���;, <br />,_i .LI�;�,• f„__ .�- <br />