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ki <br />City of Everett <br />Sewer Application <br />NO 26138 DATE <br />fJ <br />'r <br />S8?'a988 8 <br />fJ <br />ansl. Permit R <br />_ Zril B LIM <br />CHART <br />k8\0 <br />Service Address loth Pl ry Utility Account No <br />Billing Address P,O. WxM7 — <br />City, State, Zip — <br />Owner (Mortgagor)_ Wai.m, c Emit', <br />Billing Name Games <br />Connection By__ Sams <br />Address ----IWma— <br />Phone <br />DESCRIPTION: <br />Lot a Block <br />Plat w1by Pl. <br />Unplatted Description <br />Type Permit: <br />Remarks: <br />IMPORTANTI <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259 M1 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Permit Fee_-i0 nn <br />Connection Charg0s) 270,00 <br />Total Fee 10,00 <br />Special Utility Fee Ord. 1171-85 <br />avatar 179.00 <br />sewer 471.00 <br />650.00 <br />Signed_ <br />Sewer District_ nma TT <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Trunk <br />Lateral_ <br />Abutting Lot Line <br />N, S, E, W_ <br />Approved By nrsnnn ti m�myi. <br />GP, Engmeet <br />Issued By?uav n.,,qs_ <br />Inspection By V ^ <br />Date Inspected l I �3`g7 <br />No. 263.38 <br />INSPECTION <br />