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everett CHART NO. <br /> � <br /> City of Everett <br /> Sewer Application and Pnrmit <br /> rvo. 26539 DATE rreru.ro 1 y 14gg__ <br /> Service Address +��� _ �nn.h s� tp �113 Utility Account No. <br /> Billing Address_ s... I <br /> Permit Fee_ �n nn <br /> City, State, Zip �....c�, ra w�eu Connection Charge�s) <br /> , Owner (Mortgagor) a..��.,. �r��e� _ Total Fee 10.00 <br /> ' Billing Name n.� <br /> • Connection By <br />� Address_ I <br /> Signed <br /> I1 cuuortr, <br />� Phone +��._7ii� � <br />� DESCRIPTION: <br />� Sewer District ��d =g <br /> Lot�_ Block <br />� Plet _ �.�....r x�•.e■ Monthly Sewer Service <br /> Unplatted Description Monthly Sewer Constr. <br /> I Type Permit: Trunk <br />, Lateral <br /> Remarks: <br /> Abutting Lot Line <br /> N, S, E, W ft. I <br />' — 1�!18/Hg 1:':1IFM OUIINN'7217 tiil <br /> NI M l�NIt111 f1 � <br />� <br /> Approved By t:LCC ;;:;i,1,v7 <br /> � <br /> IMPORTANTI �'���'��� +lO.Ut� <br /> CALL 1�00424•6666 48•HOURS Issued 8y <br />� t IPRIOR TO DI(iGING <br /> CALL 269A811 FOR INSPECTION � <br /> Inspection By <br /> Date Inspected <br />, SEE SKETCH ATTACHED Na. 26539 I <br /> If�:�Pf_CTIUi�: <br />