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everett <br />e = _._ _,,� <br />Ciry of Everefl - - % � :�r ;t _ - _ _ <br />Sewer Application-a�nd Pe�r�it_ � �a <br />_ :•,1,��_-'�^�_ <br />� � '� � = _. 4 � ,J h ' . �i <br />NO. 2% 9 71 DAT�- octoba� e• � o�o <br />Service Address _G010 ""-'`'-�,...+.�'�; —r-==-�" UNlity Accouni No. <br />BIIIing Address <br />City, State, Zip Permit Fee $ <br />Owner • Connection Charge <br />H �]� . . <br />Con�ection by <br />Address <br />Phone <br />Legal Descr(pilon: <br />Trunk <br />Lateral <br />CHART NO. <br />:; <br />� <br />� <br />TO POSTING._ � �- Z <br />$ -�}�------ <br />$ - <br />Total Connection Charge $ �^ ^ — <br />Ulility Development FeA <br />Water $ »o nn <br />�o� seWe� $ . <br />Block TotalDevelopmentFee $ Ren_nn <br />Plat - <br />Unpletted Descrlption: Sewer Bond District <br />Type ol Permit <br />Remarks <br />IMPORTANTI <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 253•8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Abulting Lot Line <br />N, S, E, W — <br />Approved By _ <br />Issued Ely <br />Customer Signalure <br />Inspection By � /�'"�` y <br />Date Inspected ti� G� y� <br />tr�sr�r,c � io, < <br />No. 27971 <br />tt. <br />