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��� <br />C � <br />9Hxp� <br />Hx� <br />�H� <br />�[�pH <br />x <br />��e <br />OH <br />�� g <br />cH. � o <br />H <br />Zy <br />�HH <br />g� <br />�d� <br />��� <br />HO[n <br />� <br />� <br />everett <br />� <br />City of Everett <br />y I <br />_ -ri. :Y 4�l' � .. �ly. ( <br />_ sa G � t- <br />w� .. i . <br />Sewer Application and Per`,�nit y_: <br />' � LS � ? u� Y . <br />NO. Z��i 3 7 DATE _-,;;��;��yy�---- <br />Service Address ° ��� -- <br />Billing Address <br />City, State, Zip <br />Owner T; � F T ^� <br />Connection by <br />Address »m �+ ti�e���� � <br />Phone �SQ 4NR5 <br />Legal Description: <br />Lot <br />Block _ <br />Plat <br />Unplatled Description: <br />Type of Permit — <br />P,emarks <br />IMPORTANT! <br />CALL 1-500-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Utiliry Account No. <br />Permit Fee $ <br />Conneclion Charge <br />Trunk <br />CHART NO. <br />TO PO�T'Dir 8�-an. z <br />?� ���s•'3% �t�;c: <br />�� Q,��,'ac =:` <br />,n G .�. ..� ' ' <br />"J. .w .a . <br />� �, t� � <br />;��.;� __ �a , <br />�� � � W 2 � � � � [ ' <br />..c �" "�.�., y W � sE� '. <br />Lateral <br />Total Connection Charge <br />Utility Development Fee <br />Water <br />Sewer <br />Total Development Fee <br />$ <br />$ <br />$ <br />$ ---2G1.�41 — <br />$ 688 ^0 - <br />$ 94� OB — <br />Sewer Bond District T� c.cir�d) <br />Abutting Lot Line <br />N, S, E� W — ft. <br />Approved By -- <br />Issued By M , <br />Customer Signature '` , — <br />Inspection By _ <br />Data Inspected <br />ws�� ci ior� <br />C� <br />f-J-i z- <br />No. 2a637 <br />