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everett <br />City of Everett <br />�o ��aS��►� <br />�o�,��g� <br />Sewer ApplicatiAn and Permit <br />NO. 2 8 4 3 2 DATE sO�t..n.r se. 1991 <br />Service Address �� �� �- Utility Account No. <br />BIIIing Address � • <br />City, State, Zip iwe+�ts, 11' 9Y009 <br />Owner � s�� <br />Connection by p,�w _ <br />Address <br />Phone ��c.aa <br />Legal Description: <br />Lot s <br />Block _pp:T�— <br />Plat <br />')npletted Descrlption: <br />Type of Permit t�r aoeatacl�aM <br />Remarks <br />IMPORTANTI <br />CALL 1-500-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Permit Fee $ <br />Connection Charge <br />CHART NO. <br />�r� z��st i�=aa�w, axamr,-.0 <br />/ <br />u[un�a[u�.^ <br />,�a� �a.�, <br />c��a; e�n.�x� <br />Trunk <br />Lateral <br />Totel Connectio� Charge <br />Utility Development Fee <br />Water <br />Sewer <br />Total Development Fee <br />$ <br />$ <br />$ <br />$ <br />$ <br />$ <br />kK'ri <br />Sewer Bond Dlstrict L=o 7�0 <br />Abutiing Lot Line <br />N, S, E, W ft. <br />Approved By <br />Issued By J 1bcic�wil <br />—____.. <br />Customer Signature ' ' -- <br />Inspectlon By �'� —�-,�7(� <br />Date Inspected �/3 � �9/ <br />INSPECTION <br />No. 28432 <br />