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everett <br />e <br />City oi Everott <br />CHART N0. <br />���,Es ,,� r� �,,�,� ,,�� <br />� � �� <br />SewRr Application and Permit <br />No. �542g OATE �_� <br />�i� 1ostL acnvic e.:. <br />Service Address _ _ Utility Account No. <br />1i01B l�th A�►nu� M.it. ��� <br />Billing Address _ Permit Fee <br />l�attl�, Ifa. 981�5 �70.00 <br />Ciry, State, Zip Connection Charge�s►__ <br />Owner (Mortgagor►�� ��'iQ�°� �°' <br />Billing Neme <br />Connection By _ <br />Address _ <br />Phone_ ���16 <br />DESCRIPTION: <br />Lot =� Block <br />Plet �_ � <br />Unplatted Description <br />Permit: Mwr Cauwetlm <br />� Remerks: <br />IMPORTANTI <br />CALL 1800d24-6566 48•HOURS <br />PRIOR TO DIaa1NG <br />CALL 269A811 FOR INSP[CTION <br />SEE SKETCH ATTACHED <br />Total Fee_ �'� <br />Ordln�nw ).17-1l5 <br />Mabr 179.00 <br />l�wr �71.00 <br />650.00 <br />Signed � <br />cue�omer — <br />;iewer <br />L^�E�3 <br />Monthly Sewer Service_ 6•� <br />Monthly Sewer Constr. <br />»0.00 <br />Leteral <br />Abutting Lot Line <br />N,S,E,W <br />Appi oved By �f �• �� _ <br />pry Enqmtw <br />e. �ma <br />�ssued ev_ <br />Inspection By�J/ ` <br />_` <br />Date I nspected Z� 3 _ <br />No, 25426 <br />If.:T'GCTIOiV <br />