Laserfiche WebLink
everett � <br />�� <br />�„ <br />r• <br />c- <br />a <br />� <br />Ctty of Eve��elt � Q � <br />�� <br />Sewer ��lication and Permit <br />� <br />� � �, <br />NO. � Z DATE �. s, iv9L <br />ServiceAddress �asat�ka:ad-tld <br />Billing Address " ` — <br />City, State, Zip — <br />Owner - — <br />Conneclion by , <br />Addresa — <br />Phone _ <br />Legal Description: <br />CHART NO. <br />Utllity Account No. — <br />PermitFee $ � <br />Connection Charge <br />Trunk <br />Latorsal <br />Se �� -I„ <br />� <br />$ <br />Total Conne�hian Charge $ <br />Utility Ge�•elopm+�nt Fee <br />Water <br />�pt 6 —_ Sewer <br />g� � � Total Development Fee <br />Plat <br />Unplatted Descriptlon: _ — Sewer Bond District — <br />Type of Permit � � <br />Remarks <br />IMPORTANTI <br />CALL 1-800-424-5555 48-HOURS <br />PRiOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Abuttinp Lot Line <br />N, S, E, W <br />Approved By <br />$ <br />$ <br />$ <br />�a��,.� � <br />�-z6 -9� <br />Ir.sued By _. J Iaak�ll <br />i <br />Customer Signature � �/ � �, <br />Inspectlon 6y � ' <br />Date Inspected <br />INSPECTION <br />No. 28295 <br />ft. <br />