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e�eren <br />� <br />City of Everett <br />Sewer Application and Permit <br />n,o. 25949 DATE �.e�..= 4„ i9ee <br />Service Address_ »�a nae.w a� ca <br />BillingAddress_�].3Q *srl�• n��vw._ _ <br />City, State, Zip c�..�,.,�.f.�., e ow�on <br />Owner (Mortgagor) r+.+,+...� e_���..,rr <br />8illing Name a... <br />Connection Ev_jjoyq�u C^^���+•cLlnn <br />PhonE 568-790t 1r�hett� <br />DESCRIPTION: <br />Lot <br />Plet <br />Unplatted Descri <br />Typa Permit: � <br />Rem .rks: <br />Block <br />IMPORTANTI <br />CALL 1�800�424�555548•HOURS <br />PRIOR TO DIGGING <br />CALL 258E811 FOR INSPECTION <br />SFESKETCH ATTACHED <br />CHART NO. <br />Utility Account No. _ <br />Permit Fee an_nn <br />Connection Chargels)__ van_oe <br />Total Fee_ an_on <br />Special Utility Pao, Ord. 1171-BSc 5400.00 <br />Signed <br />c�,�o�, — <br />Sewer Districl_ � III _ <br />Monthly Sewer <br />Monthly Sewer Constr. <br />Trunk <br />Abutting Lot Line <br />N,S,E,W_ <br />Approved By� ��y <br />��v ��9��er <br />Issueu 8y�pt R r�y�� <br />_ft. <br />/� <br />Inspec:tion By. ���� I <br />Date I nspected •�� l� 7/`iv�_ __ <br />No. 25949 <br />If!:��f'I �:�� iui� <br />