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evereri <br />I <br />I, City of Everett <br />Sev�er /�pplication and Perm�t <br />� N0. 263g� DATE �- 2. I--��;-� _ <br />;HART N0. <br />Service Address— F- �- �`� ��?'=� ST Utility Account No. %, i:� "%'� ' � <br />Billing Address _ Permit Fee <br />' City, State, Zip Connection Charge�s) <br />i <br />IO�vner (Mortwgor) Totai Fee. <br />Billing Name <br />i Connection By ��. � i�i '� t 1- i i„ � r`- i S _ <br />IAddress Signed <br />I Phone <br />CESCRIPTION: <br />i <br />Lot <br />Plat <br />i <br />i Unplatted Descr <br />i Type Permit: <br />IRemarks: _, <br />rv, f3 , ,✓ <br />I � P UC <br />I �7AiJr <br />�� ' U <br />�S'N <br />Sewer District <br />Block <br />Monthly Sewer Service _ <br />_ Monthly Sewer Constr. <br />r� <br />MR,,�, i� ' � . ic� <br />^ �� � ' <br />/�� . �� ��_ - � <br />% �i <br />_ii! c �.� �. <br />p / /Y7/� l:, �-%TI-I <br />r <br />IMPORTANT! <br />CALL 1-800-424-5555 46-HOi1R5 <br />PRIOR TO DIGGING <br />CALL 259-8871 FOR INSPECTION <br />SEESKETCH ATTACHED <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />City Enginecr <br />Issued By I�:r� r.1 /�`� �( �� v' <br />Inspection By �--� //6-"f--`�--<� <br />Date I nspected � - � - � � <br />rvo. 2639Q <br />l( � iLl-fY EIL1_!P!�; <br />