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E <br />City of Everett <br />Sewer Application and Permit <br />f,o. 25578 DATE <br />Service Address_—�j`iL�t/� _ Utility Account No. <br />Billing Address _ Permit Fee__ t� <br />City, State, Zip r Connection Charge(s) <br />2_^ <br />Owner (Mortgagor) � Total Fee � <br />X <br />Pilling Name <br />r, icy --- <br />Connection By <br />Address_ <br />Phone <br />DESCRIPTION: <br />Lot 1— <br />Plat <br />Unplatted Description <br />Type Permit: <br />Remarks: <br />Block__ <br />IMPORTANTI <br />CALL 1 BDO424.5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259.8811 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Signed <br />Customer <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Abutting Lot Line <br />N, S, E, W, <br />Approved By <br />City Engineer <br />Issued By <br />Inspection By ff <br />Date Inspected'21-84 <br />No, 25578 <br />INSPECTION <br />