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everett <br />� <br />Cite� of Everett <br />CHART NO. <br />-� Eiv: ?'n Ci..�.c �:•vi. /3/9C. <br />Sewer Applicatior� and Permit <br />NO. ZJ�ZO DATE ��1•er <br />Service Address 2220 - 116t� et rax Utility Account No. <br />Billing Address <br />City, State, Zip <br />Ow�er (Mortgagor) rrrr.r h_ �,■�„� <br />Billinq Name <br />Connection <br />Phone�» _ <br />DESCRIPTION: <br />lot Block <br />Plat <br />Unplatted Descriptio� <br />Type Permit: , <br />Femarks: p�id 6► I.2� 719 l►q��nt <br />oin»r) b�loa�l�]1/86e dlia etrona <br />IMPORTANTI <br />CPLL I-BOOd24-555548�HOURS <br />PRIOR TO DIGGING <br />CALL 259A811 FOR INSPECTION <br />SEESKETCH ATTACHED <br />Permit Fee_ ��� __ _ <br />Connection Chargels) <br />Tutal Fee_ ]e_00 <br />Sp�ci�l Ot1IStr TM I17I-OS <br />8sw:• 400.00 <br />Signed <br />Cusromer <br />Sewer District w+nr itr <br />�W2.):�fAS •�s4.'PR IN�tkHt._�;!C' llAt <br />Monthly Sewer Service J __ <br />�+iOU_:.5: I i <br />Monthly Sewer Constry�}�;�:� <br />IyY�III <br />Trunk ,-, _,, <br />—�-�--- -- <br />1.;ti�Fi :li.txi <br />La,eral <br />Abutting Lot Line <br />N, S, E, W <br />Approved By �r.�acn tt_ Tye�*. <br />C�iy Enqineer <br />Issued Bv M_=q.t.* te_ w.r�...� <br />_ft. <br />� <br />Inspection By _ _ <br />Date Inspected_ �( ` ' r_ <br />No. 25820 <br />IF;I;!'I�..11t)f6 <br />