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CHART NO. <br /> everett �v 'o�,ti� <br /> r.n�l �(RI <br /> City of Everett �n;�li�� >:w'r�;is arof�s;;�;, ; � _ ; <br /> Sewer Application and Permit ���:�=� <br /> t: r�h.cH ��i.°;�� <br /> Vi00tk.^P'�S <br /> � SE'WER 14.�0 <br /> N0. 283?5 DATE aulv 1 1�1 �`_F ;� a ,. <br /> Service Address �?� "�""'�"' — Utility Account No. - <br /> Billing Address <br /> i <br /> City, State, Zip Permit Fee $ � s� <br /> � Owner --�''' Connection Charge <br /> � Trunk $ <br /> ( Connection by <br /> � Address Lateral $ <br /> � Total Connection Charge $ — <br /> � Phone �•- •��� Utility Development Fee <br /> i. <br /> Legal Description: Water $ <br /> ` Lol 18 i 19 Sewer $ <br /> t Total Development Fee $ <br /> � Block <br /> i Plat ��q �d W'• l�t 1k1dn to L^wrstt <br /> Unplatted Description: Sewer Bond District <br /> Abutting Lot Line <br /> NSEW ft. <br /> Type ot Permit G1t-oi!' ' Approved By <br /> r7 <br /> Remarks P Issued By <br /> � � � Customer Signature <br /> IMPORTANTI <br /> CALL 1-800-424-5555 48-HOURS <br /> PRIOR TO DIGGING <br /> Inspection By <br /> CALL 259-8810 FOR INSPECTION Date Inspected <br /> SEE SKETCH ATTACHED NO. ZH3ZrJ <br /> INSPEC1lON <br />