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II <br />everett <br />� _ --- <br />- .i `. .i -f., .1 Y.' =f i <br />City of Everett -= ' � � � _ � <br />�, ;� , �. � <br />:: :.. :. .' <br />:� <br />Sewer Appl6cati�r+ ar�d�Perr�it ;� . . <br />�. �r � � ii�� <br />J�4 fy.. � yr g} W• <br />,� �.���;'_r � -��' <br />NO. Z H�? 7 DATE ��Tr o, , ao� <br />Service Address �d�^ a-c-a-..t�►�wrly-alv=r— <br />BillingAddress R4z--d'—'� —�r-^' � <br />City, State, Zip �-�-tt,_trn�82o�- <br />Owner �•��.�---- <br />Connection by _ <br />Address <br />Phone <br />Legal Descriplion: <br />Lot <br />Block <br />Plat <br />Unplatted Description: <br />Type of Permit _rmr corrtrscrrot� <br />Remarks __. <br />IMPORTANT! <br />CALL 1-800-424-5555 46-HOURS <br />PRIOR TO DIGGING <br />CALL 259•8810 FOM INSPECTION <br />SEE SKETCH ATTACHED <br />Utiliry Account No. <br />Permit Fee $ <br />Connection Charge <br />CHAR i' NO. <br />y9 <br />�� <br />z� <br />� <br />:� <br />TO POSTING �-��-4z <br />Trun!c <br />Lateral <br />Tutal Connection Charge <br />Uliliry Dev�lopment Fee <br />Water <br />Sewer <br />Total Devotopment Fee <br />$ �nn nn <br />$ —� <br />Sewer Bond Dishict —_i_(zot,t,ra3}- <br />Abutting Lot Line <br />N, S� E, W ---- it. <br />Approved By -- <br />Issued By -- <br />�� /� 9, <br />Customer Signature ' �<-C: �* � �'� �� �c����' <br />Inspect��n By _ <br />Datelnspected <br />i�,Si�Erri-.��� <br />No. 28:177 <br />� ..,..� ... <br />