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CHART NO. <br /> e:•erett <br /> ., <br /> � <br /> �� <br /> 1: <br /> Y <br /> � c- <br /> � � c <br /> City of Everett � 4 .a <br /> �, TO POSTING a� �- <br /> Sewer ,�pplication an�����mit <br /> � � <br /> N0. Z 8 6� rJ DATE e� �}r�g9� <br /> Service Addresa — Utility Acco�nt No. <br /> Bllling Address <br /> City, State.Zip Permit Fee $ — <br /> Owner _ �+. � o—=�- Connectlon Charge <br /> Connectlon by Trunk $ — <br /> Address Lateral $ <br /> _�_ Total Connection Charge $ <br /> Phone u� n�a -- Ulility Development Fee ' - <br /> Legal Description: Water $ <br /> �� _ Sewer S <br /> Block _ Tmal Development Fee S - <br /> Plat ------ <br /> Unplatted Descrlplion: Sewer Bond District <br /> Abutting Lot line <br /> N, S, E,W �' <br /> Type o� Permlt N.r e uetiee Approved By <br /> Remarks Issued By— ' <br /> _ Customer Signature -- <br /> IMPORTANTI <br /> CALL 1-500-424-5555 48-HOl1RS � �� <br /> PRIOR TO DIGGING <br /> Inspection By <br /> CALL 259-8810 FOR INSPECTION 7 _ � y �Z_ <br /> Date Inspected — <br /> SEE SKETCH ATTACHED N0. �L86OS <br /> � wsr�r..clion� � <br />