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everett <br />e� <br />p '��a. i� '..�'M.0 <br />e�c� _ . <br />City of Everett d , o-- � �; U 4 <br />c ���~y�� �, ,f �� Permit <br />Sewer �p �ic�ti��3.n�� <br />� �c 5� � � �_ '"- <br />�� � � <br />��n�����Oct.3.1991 <br />NO. � ��� DATE <br />Service Address 610Z 6rookriEq� elvd _ <br />Bllling Address � �' �06 <br />Ciry, State, Zip -�", � oaa�e — <br />Owner J. 8hort Cautruction <br />Connection by �� L�' �"'"y ��� a c <br />Address <br />Phone 33t-382Y — <br />Legal Description: <br />Lot <br />Block —'— <br />Plat -- <br />Unplatted Descrlption: <br />Type of Permit - ---•' <br />Remarks <br />IMPORTANT! <br />CALL 1-500•424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Ulility Account No. <br />CHART NO. <br />-� nn�T�Nf �' �2 � tiz <br />Permit Fee $ _ 30 00 --- <br />Connectlon Charge <br />Trunk <br />Lateral a <br />Total ConnecNon Charge b <br />Utility Developmenl Fee <br />Waler <br />Sewer <br />Total Development Fee <br />Sewer Bond Districl ___ <br />Abutting Lot Llne <br />N, S, E, W <br />Approved By <br />$ 179 00 <br />a 471.00 <br />§ 650 00 <br />Issued By �--- <br />/ <br />Customer Signature <br />�,l �—_ <br />Inspection By _ �`� `" <br />Datelnspected �L���-y� <br />ItJSPLCTI(i:l <br />No. 28439 <br />n. <br />� <br />