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� ov¢r�tt <br />�i <br />I <br />� <br />'i City of Everett <br />5e�nrer Appiice�tion and Pers°r�it <br />No. 25376 DATE �� ' ` <br />i CI1r� 1' �i fi} �'7'F <br />Service Address <br />Billing Address_ ��-� ���— <br />C <br />City, State, Zip � <br />pwner (Mortgaaor) -'-��--- <br />/� _ _1 rn �. .. � I <br />Billing Name , � <br />Connection <br />Address <br />DESCRIPTION: <br />Lot _--- <br />Plat __----- <br />Unplztted Description <br />Type Permit: <br />I Remarks: <br />i <br />Block <br />IMPI �RTANT! <br />CALL 1�600-424-5555 48-HOURS <br />PRfOR TO DIGGINf, <br />CALL 259-8811 FOR INSPECTION <br />SEE �KETCH ATTACHED <br />Utility Account No. <br />Permit <br />Connection Charge(s) C�_ <br />Total Fee. / � <br />f� ��,,� <br />Signed �x�- :' <br />. �customer <br />Sewer <br />Monthly Sewer <br />Monthly Sewer Constr. <br />Abutting Lot Line <br />N, S, E, W <br />qpproved By_ <br />CitV Engineer <br />y ii� <br />Issued Rv / � �u vv'«F+-,- T-r--� �C� <br />j� ��je`Hldi4 <br />I nspection �y✓ <br />Qate Inspected �'1-����� <br />No. 25376 <br />I i�1S��CTi 01'�: <br />z <br />0 <br />-� <br />n <br />m <br />H 1�� <br />� T� <br />H �{ <br />�' m <br />co <br />m o <br />c� <br />�� <br />om <br />i -+ <br />r*� <br />.C7 L <br />c <br />r = <br />�� <br />-�i (n <br />< <br />� <br />o� <br />-n a <br />--I m <br />S <br />m� <br />or <br />nm <br />c v� <br />3 � <br />m <br />-z-t r�' <br />. rn <br />a <br />� <br />