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everett <br />c <br />City of Everett $$ 8$ S S g g 8 <br />Sewer Application an j? mit <br />NO. 25781 %ATE July <br />Service Address <br />Billing Address_ 005--"tM-{gyp-N-- <br />City, State, Zip <br />owner(Mortgagor) <br />Billing Name <br />Connection <br />Address <br />Phone <br />DESCRIPTION: <br />Lot Loth—. Block <br />Plat — <br />Unplatted Description <br />Type Permit: u <br />„2r+�,11AAP.0 <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 />CHART <br />L 18-2B-5 <br />Utility Account No. <br />Permit Fee—jq- <br />. qq----- <br />Connection Chargels)___ le - <br />Total Fee -;I"q — <br />Sneclal Ut111ty ree Ord. 1171-*{5 <br />Water 179.110 <br />Sewer 471.00 <br />5'? f10 <br />Signed_ <br />Sewer District_�� <br />Monthly Sewer <br />Monthly Sewer Constr. <br />Trunk — <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />Issued By nYaiT <br />Inspection By / ' <br />Dale Inspected�L� NO. 25781 <br />II::� [Gilt ;! <br />