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everett <br />� <br />Ciiy of Everett <br />CHAHT N <br />Sew�r ���pBeca���re an�l Permit <br />N0. <br />; � ;i �J =.. _ DATE � <br />Service Address_ �� ��� Utility Account No. <br />Billing Address <br />City, State, Zip <br />Owner ( <br />Billing Name <br />.. '�� <br />Connection By <br />Phone <br />Permit Fee �� — <br />Connection Chargel <br />Total Fee_ �— <br />�\ �/�� <br />Signedy�__�Q}1—I , I! �. �- t' r`y <br />Customcr <br />DESCRIPTION: Sewer Oistrict <br />Lot Block Monthly Sewer Service. <br />Plat <br />Unplatted Description Monthly Se�r✓er Constr. <br />Trunk <br />Type Permit: � p� �G� <br />Lateral <br />Remarks: <br />n; . -,. —/,� �- , <br />� <br />� <br />�/h-�.�!7-t/� <br />/ r // �� n//i . <br />IMPORTANT! <br />C�LL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8811 FOR INSPECTION <br />SEESKETCH ATTACHED <br />Abutting Lot t_ine <br />N, S, E, W <br />Approved By <br />Ciry Engineer <br />Issued By � <br />� , �, :f.�. <br />Inspection By ' '"��=�' 1��� � <br />�; <br />Date I nspected /-� �- . � U. 4'l-• <br />NO. <br />