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everett <br />S. <br />u' <br />d <br />a <br />City ot Everett �;� = � � '� Q � � `' <br />i r '� , ; � ; �� "; <br />- :A t � .• ��� <br />Sewer �pp�icatio�i_ a�d Permit <br />NO. �$��� W � LIATE� _ �it/�/oo <br />Service Address «�A n s�rl,-Ylvd - <br />Bflling Address 921U Evrrnreen L`iv_ _ <br />Clty, Sta�e, Zlp �ar r ve oA2tt� _ <br />Owner ��,� _ � �_..,__ r.,.. _ <br />Connection by <br />Address <br />Phone _ <br />Legal Description: <br />Lot <br />F][•*�.9 <br />Utility Acc�unt No. <br />CHART N0. <br />i�-�,# � �oS�.� <br />�-3-4r <br />PeraitPee $ __ 30.00 <br />Connecilon Charge <br />Trunk <br />Lateral <br />Total Connection Charge <br />Utiiity Development Fee <br />Water <br />Sewer <br />Total Development Fee <br />PI81 linverly�`ark Ilir lin_Z_ <br />Unplatted Description: _ — Sewer Bond Disiricl <br />T�roe o( Permit <br />Remarks _ <br />IMPORT/INTI <br />CALL 1-500-424-5555 �.S•HOURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTIOM <br />SEE SKETCH A7TACk1ED <br />Abuding Lot Line <br />N,S,E,W — <br />Approvad By _ <br />Issued By <br />Customer Signature <br />$ <br />$ <br />$ <br />$ 179.U0 <br />$ 471.00 <br />g 650.00 <br />R. <br />Inspoction By _ /b` �oc,c c _ <br />Date Insp�tcted — � � � ' 9' — <br />RJ:�f'[�CTION <br />No.28o02 <br />