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CHART NO. <br />j everett " <br />� � <br />I � � <br />� <br />I gs�e�� c gggQ, <br />City ot Everett � o�e �� o �� o� m <br />�i;, � �^ '" « 5t �' . <br />Sewer A�p�'cati�n��r�d...P�?�rmit <br />� � � � J � �L � � �l �:i rr t� <br />N0. 2� � � . DATE �or."�".r-- <br />ServiceAddress »� ���""•"-" e�"d UtllityAccounlNo. <br />Bllling Address <br />City, Stete, Zip Permit Fee $ <br />Owner � Connection Chargo <br />Connectlon by _� ,l � %�� �' Trunk <br />Address — <br />Phone _. <br />Legel Description: <br />�� <br />Lateral <br />Se,,f � pos(,,w 7-�?-4i <br />Totnl Connection Charge $ — � � ^ ^^ <br />Utility Developmenl Fae <br />iA�8i0f <br />Sewer <br />$ SNO Nf1 <br />Block _ — Total Devetopment Fee $ <br />Plet <br />Unplatted Descriptlon: Sewer Bond District �,�--- <br />Abuttlng Lot Llne <br />Typo oi Permlt �-- <br />Remarks <br />IMPOHTANT! <br />CALL 1-800•424-5555 48•HOURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />N, S, E, W <br />n. <br />Approved By, _ <br />Issued By J 1Mackwll -- <br />Customer Signature <br />Inspection By <br />Datelnspected <br />irisE�rciio�� <br />/ <br />� � <br />( t l .� , , /.,,� <br />, i �%��-�C�� �! <br />N0. Z�8�1 <br />� <br />