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everett <br />� <br />City of Eve►eri <br />Se°{ve:r ApNlication and Permit <br />NO. [�7667 DATE we.,rh z�� l000_ <br />Service llddress_�_ <br />Bill(ng Address_ --- <br />City, State, Zip n•••••ti�aq►_�s10�— <br />Owner (Mortgagor) Lrrv ��a■ _ <br />8illing Name_ — --- <br />Connection By �► a �^��+� --- — <br />Address — <br />DESCRIPTIOiV: <br />Lot_ Block <br />Plat <br />Unplatted Description <br />Permit: <br />Remarks: <br />IMPORTANT! <br />CALL 1-600�424-555G 4A�HOURS <br />PRIUp TO DIGGING <br />CALL 269A811�iOR INSPECTION <br />SEESKE7CH ATTACHED <br />CHART <br />-r'o f�-�'r-t r��S <br />S - � �- 90 <br />II:i.:.JS'll .:,}'�yj �111;;1`�d.l1L�: .i�'. <br />/ <br />��•ux�7bt,� <br />'.d:lA:r y"U.iw, <br />fIlFf.l: ' al �,ti� <br />Utility Account No. --- <br />Permit Fee__ '+� �+ - <br />Connection Chargels) <br />Total fee�__ <br />Signed — <br />customer <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Trunk <br />4butting Lot Line <br />N,S,E,W <br />I%�PProved By ..*�p nt TnQ.r_ <br />Cny E� p��en <br />I Issued By__ • ^--•`--'+ <br />, / , <br />Inspection 6y �^c.c.�4����a1,3'�=Z��— <br />Date I nspected_ _ 3 �� � U <br />No. 276(i�l <br />li i:�l''i�.'.-il� `i�; <br />