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everett <br />� <br />City of Everstt <br />Sewer Application and Perrnit <br />NO. ���ou DATE �i"' <br />� - <br />Service Address ' � � ' ' � =— <br />-- \ . ._� �� -.- <br />Billing Address I � � 'a _! ✓ t <br />CitY. State, Zip _ � ' !- /- � ' �� ' / ' / .� � <br />Owner (Mortgegor►� �) 1 _ ' '_ � _ <br />8flling Name_�_ � � - ' ' % ' <br />CHART <br />- - - . •s.,�� <br />��5�96 <br />Utility Account No. <br />Permit Fee._ <br />Connection Charge�s►_ _ - ' — <br />� <br />Total Fee _ �_ <br />, �.J� , l c _ 1l /l <br />i�, ,_ ; �/ <br />Connection By __ I�i .._ ___ � i, � <br />, - <br />Address � / _� � r _ _ Signed �' - <br />c omer <br />Phone / <br />DESCRIPTION: Sewer Uistrict__ <br />Lot Block <br />Plat _ - �' c_ Monthly Sewer Service__ <br />Unpletted Descrip!ion _. _ Monthly Sewer Consti. <br />Yypa Permit: j�� �� <br />Remarks: <br />IMPOHTANTI <br />CALL 1AOOd24•66fi6 48�HOURS <br />PRIOR TO DIQ61N0 <br />CALL 269A811PORINSPECTION <br />SEE SKETCII ATTACHED <br />Abutti�g Lot Line <br />N,S,E,W <br />Approved By _�. <br />Citv Enpmee� <br />Issued Oy � <br />i <br />Inspection By�'/�'"� _ <br />Da[e I nspected 3" « . <br />No.' 25488 <br />iC ��:'.��n, <br />