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� <br /> i <br /> CHART N0. <br /> everett �' <br /> � 7� ���,� <br /> � <br /> city ot Everett � o o !U�(o�Q <br /> i� w �� / / <br /> Sewer �p�lication and Permit <br /> � <br /> NO. 2�9 � J DATE _��y.s�, ,a�_ <br /> Service Adrlress �il� �• eaL-= Utiliry Account No. — <br /> BIIIing Address <br /> City, State, Zip �srtt, all Oi'Oi Permit Fee $ _lp�,pn <br /> Owner Cannectlon Charge <br /> Connection by �� �� Trunk S <br /> Address Lateral $ — - <br /> Total Connectlon Charge $ <br /> Phone Utility Development Fee <br /> Legal Descrfptio�: Water $ <br /> Lot Sewer $ <br /> Blxk Total Development Fee 3 <br /> Plat <br /> Unpletted Description: Sewer Bond District <br /> �Q��"��-� Abutting Lot Line <br /> � <br /> UV � N, S, E, W ft. <br /> 0 <br /> Type of Permit ���a Approved By — <br /> Remarks �.� Issued By * TM�+�—�� <br /> 'I <br /> Customer Signature <br /> IMPORTANTI <br /> CALL 1-800-424-5555 48-HOURS <br /> PRIOR TO DIGGING <br /> CALL 259-8610 HOR INSPECTION Inspection By <br /> Date Inspe;ted — <br /> SEE SKETCH ATTACHED No. 27975 <br /> INSP[CTIOtJ <br /> � <br />