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vx <br />C H <br />1y H <br />V1 H <br />everett <br />NzZE F <br />QH <br />N08 <br />n• o <br />+y City of Everett 888�R6 SS <br />r <br />g�H Sewer icatn' nd Permit <br />tq� <br />yo y <br />No, �n Q DA goteaDer 2�_1990 <br />C:j <br />C �o <br />iC D <br />� � 1 <br />1 j <br />Service Address —1' " •""* sc <br />Billing Address <br />City, state, ZIP m! ---- <br />Owner Sato a-®�•*a <br />Connection by _ <br />Address — <br />Phone _ _. <br />Legel Descriptlon: <br />Lot <br />Block <br />Plat <br />Unpla'ted Description: <br />'Type of Permit <br />Remarks — <br />IMPORTANTI <br />CALL 1-800.424-5555 484 <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Utility Account No. <br />CHART NO. <br />Permit Fee $ <br />Connection Charge <br />Trunk $ <br />Lateral $ <br />Total Connection Charge $ <br />Utility Development Fee <br />Water $ <br />Sewer $ <br />T e.r nevnlonmont Fee $ <br />gewer Bond District <br />Abmy�QLol une <br />N, Q, E, W — <br />Approved By <br />Issued By / <br />IQ� <br />Inspection By _ <br />Data Inspocled <br />INSPECTION <br />,;Nip.. . . �.,•...... •....,..»..... �... � .. ... <br />NO.28004 <br />fl. <br />