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everett <br />� <br />City of Everett <br />Sewer Application and <br />NO. Z 8 6 H 5 DATE <br />� <br />� <br />� <br />Service Address <br />Billing Address ---raw-- - <br />Ciry, State, ZIp <br />Owner ■ b e r. x .�{� — <br />Connection by <br />Address —1 <br />�r " <br />Phone aso �s�e — <br />Legal Descriptfon: <br />�� <br />Block <br />Piat -- <br />Unplatted Descdption: <br />Type oi Permit �+ <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 />�$p <br />M + <br />mit <br />�� <br />Utility Account No. <br />Permit Fee 5 <br />Connectlon Charge <br />Trunk <br />CFIART NO. <br />TO POSTING y �`� � <br />Lateral <br />Total Connection Charge <br />lltiiity Development Fea <br />Water <br />58Wa� <br />Total Development Fee <br />Sewer Bond District _ <br />Abuhing Lot Une <br />N, S, E, W — <br />Approved By <br />Issued By M• <br />Customer Signature'.: <br />$ <br />$ <br />$ <br />$ <br />$ <br />$ <br />Inspection By �"' "'�`��— <br />Date Inspected ��� s � <br />INSPECTION <br />No. 28685 <br />ft. <br />"�"F <br />+ <br />� <br />