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u <br />everett <br />City of Everett <br />Sewer Application and Permit <br />NO. 2$OHZ DATE �— 5��i I <br />Service Address z 5 �'� ��" n)4 f�C<%A�` Utility Account No. <br />Billing Address <br />Ciry, State, Zip <br />Owner <br />Connection by G L'�,'�� O� C/.t� I�P.�' _ <br />Address <br />Phone <br />Legal Description: <br />Lot <br />Block <br />Plat <br />Unplatted Descriptiun: <br />CHART NO. <br />Permit Fee $ <br />Connection Charge <br />Trunk <br />Lateral <br />� otat Connection Charge <br />Utility Development Fee <br />Water <br />Sewer <br />Total Development Fee <br />Sewer Bond District <br />Aburiing Lot Line <br />N 5 E W <br />$ <br />R <br />$ <br />$ <br />$ <br />$ <br />,,, n. <br />Type of Permit FiP r��9 V�JC.Q !� ���� ��- Approved By <br />Remarks ,$P �Q/L �L�r�in �oD Li A.'t Issued Ey � �/� M/ �f� �"' <br />7�i'J Gv2� �.� ;'� �' � P �C • Customer Signature — <br />� �AnJ ��MPORTAN�� � �.v.e.. g , ��� @ ��� 6 . <br />3' 7�e.� @ P�P � c. , �v� <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING `,� / <br />CALL 259-8810 FOR INSPECTION Inspection e <br />Y <br />Date Inspected -3�� ��9 / <br />SEE SKETCH ATTACHED No. 2 8 0 8 2 <br />CUSTO".96R COPY <br />