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everett <br />�e� <br />City of Everett <br />TO POSTING 4 <br />Sewer Application and Permit <br />No.28604 DATE <br />Service Address 7819 ft.,mr ,y lane _ <br />Billing Address — " <br />City, State, Zip fteratt, WA 90203— <br />Owner may Morberg <br />Utility Account No. <br />Permit Fee $ <br />Connection Charge <br />CHART NO. <br />02/10/V Sol" 00MY42231 <br />/ <br />11000213604 <br />$111.01) <br />CASH 130.00 <br />Connection by Owner <br />-- Trunk $ <br />Address <br />-- Lateral $ <br />Total Connection Charge $ <br />Phone _ <br />Utility Development Fee <br />Legal Description: <br />Water $ <br />Lot <br />— Sewer $ <br />Block <br />Total Develop vent Fee $ <br />Plat <br />Unplatted Description: <br />Type of Permit litre mNIOCTMN <br />Remarks <br />IMPORTANTI <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Sewer Bond District . <br />Abutting Lot Line <br />Vt. <br />N, S, E, W —_ tt• <br />Approved By <br />Issued By 3 Aockwsll <br />Customer Signature <br />Inspection By at'a-� <br />Date Inspected 7-- Z' — 9 2 <br />INSPECTION <br />NO.?.8604 <br />