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everetl <br />e <br />City of Everett <br />Sewer Application and Permit <br />No. 25688 DATE �`` /C— a C^_ <br />Service Address ✓ n 6;2 6�10 s >�, Utility Account No. <br />Billing Address — T _ Permit Fee <br />City, State, Zip Connection Charges) <br />Ownei (Mortgagor) <br />Billing <br />Connection <br />DESCRIPTION: <br />Lot Block <br />Plat <br />Unplatted Description <br />Type Permit: <br />Remarks: <br />IMPORTANTI <br />CALL 1-800.424.555548-HOURS <br />PRIOR TO DIGGING <br />CALL 259.8811 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Total <br />Signed <br />Cutlomer <br />Sewer District_ <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />City Engineer <br />Issued <br />Inspection By <br />Date Inspected_ <br />No. 25688 <br />INSPECTION <br />