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everetl <br />e <br />City of Everett <br />Sewer Application and Permit <br />No. 25340 <br />Service Address_ <br />Billing Address_ <br />City, Stete, Zip_ <br />1�/30/!s <br />DATE _ _ <br />91i 1�StL il� s.t. <br />9422 �ed il�a 6.E. <br />tv�z�tl� IM, f9201 <br />Owner (Mortgagor) � �~_ ��t' <br />Billing Name.. ___ <br />Connecticm 8y_ <br />Address <br />.._-- J�7-2SJ0 <br />CHART NO. <br />S�rirJT 1t�,� C.Y.p.2Ti,-,'G <br />3-f1- r3� <br />Utility Account No. _ <br />Permit Fee �0.00 <br />Connection Charge(s) ��s•� <br />Total Fee ��•� <br />�'►�Ainane� 1171-BS <br />��r 171.00 <br />iNbt bi9.00 <br />�� `\ � , � <br />Sig�ed_�' ~ •_ <br />DESCRIPTION: Sewer District___ <br />Lot ■ Block <br />Plat _ � pl�t �l-M Monthly Sewer Service <br />Unp!atted Description __ Monthly Sewer Constr. <br />�e Permit: <br />Remarks: <br />IMPORTANTI <br />CALL 1�800d24-6556 48•HOUHS <br />{`pIOR TO DIQGING <br />CALL 269�8811 FOP, INSPECTION <br />SEE SKETCH ATTACHED <br />650.00 -- <br />lo�wi III <br />•.SO <br />7�O.no <br />Lateral i9S.00 <br />Abutting Lot Line <br />fV.S,E,W <br />Approved By A. R. !ly�1 <br />Citv E�p�nee� <br />Issued Bv �_�d <br />Inspection By � <br />Date Inspected Z�(��$(p _ <br />No. 25340 <br />IrC, f'f:r, i IOrJ <br />