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everett <br />� <br />City of Evarstt <br />Sewer Application and Permit <br />No. 25565 DC�TE _ � ' <br />Service Address_ ,�� � .-� � L �J � Utility Account <br />BillingAddress�f� )' " � -��- __ Permit Fee_ <br />c-- �, � )�}' <br />CHART NO. <br />�_ � - �., , �,�. ..fi. � � � . <br />City, State, Zip��\�� `�,j,. _ Connection Chargels►_ _ <br />Owner (Mortaagor► <br />Bifling Name _ <br />^anr�ectinn By., __. <br />Address _ _ <br />Phone ._, <br />DESCRIPTION: <br />Lot _ ! <br />Plet —_ <br />� <br />Block _ <br />Tutal Fee <br />Siyned.---- - <br />:�:� �:� <br />Sewer District <br />Monthl o Sewer Service_ <br />Unplatted Dcscription _..._ . Monthlv Sr,ver Consu. <br />Type Permit: � <br />qe.narks: � <br />IMPORTAN71 <br />CALL 1�800�24�5655 48•HOURS <br />Pq10R TO DIGGING <br />CALL 269�8811 FOP. INSPECTION <br />SEE SKFTCH ATTACHED <br />Abutting �.ot Line <br />-- N, S, E, W----- <br />Approved By_____ <br />c�p Enein.er <br />Issued By ! <br />____ft. <br />1 <br />Inxpection dy� � "� � ______ <br />Date Inspected - <br />N�. 255�5 <br />li��: "f_�.;�iION <br />