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everett <br />e <br />City of Everett <br />Sewer Application and Perm <br />? W <br />NO. 25956 DATE bt T�M1G <br />Service Address '.0 — <br />Billing Address—RO Box 997 -- <br />City, State, Zip_L4k4V4t@V4W—WA-2225^. <br />Owner (Mortgagor) <br />Billing Name <br />Connection By <br />Phone.---" <br />DESCRIPTION: <br />Lot ------- Block <br />Plat _ ro1Dy P -ace <br />Unplatted Description <br />Type Permit: <br />Remarks <br />IMPORTANTI <br />CALL 1-800-424-5555 48 HOURS <br />PRIOR TO DIGGING <br />CELL 259-6811 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />CHART NO. <br />>'p 4144:11;X 312Yge <br />888 <br />SR <br />� <br />Ny <br />Utility Account No <br />Permit Fee <br />Connection Chargels)—=,44---- <br />Total Fee 30 on <br />Special 1tt111ty Fee Ord. 1171-95 <br />water 179.nn <br />Sewer 471.00 <br />zq—. 63 <br />Signed C.'-o r <br />Sewer District Bond 11 <br />Monthly Sewer <br />Monthly Sewer Constr. <br />Trunk e+n nn -_—_ <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved By. ���� <br />Gry Engineer <br />Issued By _ -- <br />Inspection By <br />Date Inspectedy— <br />No. 25986 <br />INSPECTION <br />