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everett <br />; <br />Cily oi Everett <br />Sewer Application <br />N0. Z$� S S DATE <br />Service Address �2�' � b D ti Cabpc Rd <br />Bllling Aidrass � 5��� t nc f�f t� aa <br />CitY� State. Zip c-�F�-''h Id 1 9it29D <br />Owner �y}7*�el�e,�.k <br />Conr,ectlon by �- LU pg � r- w <br />Address <br />Phone <br />��'� Legal Descdption: <br />J� Lot 3 <br />r <br />� Block <br />1���� Plet +�- �� � e Ttaet• <br />I <br />; Unplatled Descriptlon: <br />�+ a. <br />i 4�'. <br />L <br />I � Type o( Permit - -•-vieo <br />� <br />, Remarks _ <br />IMPORTANTI <br />CALL 1-800•424•5555 46-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Utility Account No. <br />NO <br />TO POSTING�1�� <br />G• � F' <br />3 ? �; <br />C <br />,r. 'v � <br />_ <br />� <br />i� �� <br />���; <br />�� w <br />Wi=� <br />PermitFee $ �� pp <br />Connection Charge <br />Trunk <br />Lateral <br />Total Connection Charpe <br />Ulility Development Fee <br />Water <br />Sewer <br />Total Development Fee <br />3 <br />$ <br />$ <br />S 261.OD <br />$ �— <br />S <br />Sewer Bond District I (retired) <br />Abutting Lot Line <br />N, S, E, W n. <br />Approved By _ <br />Issued By _ - rn <br />Customer Signature _ � <br />/ <br />Inspection By. <br />Date Inspected <br />IfdSPCCI IOtJ <br />i ;; � ��=- - <br />, r .,,<'i ,i <br />No. 28355 <br />•xp� <br />