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� � �' <br /> �� H <br /> � CHART NO. <br /> K�� evereri - <br /> z <br /> �y H � = TO POSTING_. 3�� �'� <br /> �ix� ' - <br /> � o ^ ' � <br /> = ;� r� — _ ��c �: � <br /> � c~i g City of Everett: _ ;, �; _ ' _ ,'; �: <br /> n� � .� � � M � ' � w «. e. <br /> zy Sewer A p�licatioi� and Permit � <br /> � � p:_� _ = � -- - � � � <br /> �"�y �� .:i `:� � 1 I,i � - W <br /> g �' �- a " � _ . v -. _ ._ _. <br /> c�G� NO. �8�s� ^DATE j .�t,. 11 ,qoi <br /> �� � I Utiliry Account No. <br /> o��i+ i Service Address sso <br /> Biiiing Address <br /> Perinit Fee $ <br /> City, State,Zip <br /> Connection Charge <br /> Owner _--,p�qqp-t�2 n on <br /> Trunk $��y�— <br /> Cunnection by — $ <br /> Laterai � <br /> Address _--- 2�0.00 <br /> Total Connection Charge $ <br /> Utility Development Fee <br /> - Phone -----�— <br /> Water $ ��� °--�-�-"-- <br /> ���� Legal Description: <br /> ' Sewer $ <br /> ! Lol Z <br /> �� Total Developmenl Fee $.�13-oB---'—' <br /> � <br /> Block _ <br /> Plat g—'-- <br /> Unplatted Description: <br /> Sewer Bond District <br /> �.� Abutling Lol Line <br /> tt. <br /> I N,S,E,W <br /> i <br /> i I�1�� Approved By � <br /> Type of Permit i <br /> Issued By <br /> Remarks <br /> j � ,-' Cuslomer Signature <br /> � <br /> IMPORTANTI � <br /> '�`� � CALL 1-800-424-5555 48-HOURS , � <br /> PRIOR i'O DIGGING �j����- <br /> Inspection By � � <br /> CALL 259-8810 FOR INSPE�TION Date Inspected 3—�� -� � � <br /> SEE SKETCH ATTACHECI <br /> No. 2�3468 � <br /> INSPECTION � <br />