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ki <br />City of Everett <br />Sewer Application and Permit <br />No. 25767 DATE &L 29.1Q86 <br />Service Address 2C1 n I4th et <br />Billing Address 9400 74t"t--- <br />City, State, Zip--Evarstt uA 98203 <br />Owner (Mortgagor) Wrola -1viek <br />Billing Name C." <br />Connection By <br />Phone��? <br />DESCRIPTION: <br />Lot 3 Per 2 Block 3 <br />Plat— Ruen, Vist, IbmeTr <br />Unplatted Description <br />Type Permit: Cap off <br />Remarks: <br />IMPORTANTI <br />CALL 1-00OA24-555548-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8811 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Utility Account No. <br />Permit Fee Z 50 <br />Connection Charge(s) <br />Total Fee <br />Signed <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_... Al Theal <br />City Engineer <br />Issued By Sue Grannan <br />Inspection By K . <br />Date Inspected '26'"�E' <br />No. 25767 <br />INSPECTION <br />