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C:). <br />1 1 <br />j <br />everett <br />1� <br />a <br />City of'Evi,rett fJ d ri <br />AM � <br />Sewer Applicatla)h end Permit <br />NO. i 8 7 ? 1 Y DATE— <br />G2 3C) <br />CHART NO. <br />rn WTING .-z 2 9z- <br />Service Address *g30-Beverlj Blvd — Utility Account No. — <br />Billing Address game — <br />City, State, Zip 98203 <br />Ownernnnn.. --- <br />Il <br />Conneclionby �r0.i�,p,o. r�s ----- <br />Address — --- <br />Phone <br />Legal Description: <br />Lot -- <br />Block -- <br />Plat <br />Unplatted Description: <br />Type of Permit t t■r.tiam— <br />Remarks — <br />IMPORTANT! <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Permit Fee $ <br />10 <br />Connection Charge <br />Trunk <br />$ <br />Latoldi <br />$ <br />Total Connection Charge <br />$ <br />Utility Cevj cpment Fee <br />w�Ior <br />$ <br />Sewer <br />$ <br />Total Development Fee $ <br />Sewer Bond D'strict <br />Abutting Lot Lire <br />N, S, E. W _— <br />Approved By -- <br />Issued By <br />Customer Signature <br />Inspection By C4/1r'/.A'er^ --- <br />Date Inspected -I'd -9 " -- <br />INSPECTION <br />NO. 28721 <br />ft. <br />