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CHART NO. <br /> everett <br /> TO POSTING FEe n � zam <br /> City of EvereB <br /> Sevuer Application and Permit <br /> NO. 28732 DATE �w� 2g� 1s9� _ <br /> Service Address +�+�++ ■ ^--�-� � - ��0 �7 Utility Account No. <br /> Bllllnp Address °� � �7e� "�� Or-7f <br /> City, State,Zip �►�:�, M11 p�i�4 — Permit Fee S �e ne <br /> Owner , Connectlon Charge <br /> Connectlon by �+-�-� — TrunF, S— — <br /> Addresa Lsteral E <br /> Totel Connectlon Cherge S -a- <br /> Phone +az-ss�n _ Utllity Development Fee <br /> Lepal Descrlption: Water S 1.047.e7 <br /> Lot Sewer E � <br /> Block Total Development Fee s 1.0�7.97 <br /> Plat <br /> Unplatled Desc�iptlon: . Sewer Bond Diatrlct m-*�+ �1 <br /> Alx�ding Lot Lir�e <br /> N,g, E, yy ft. <br /> Type ol Permit __ Approved By <br /> Remarks Issued By J �u <br /> CustomerSignature � ,�` <br /> IMPORTANTI <br /> CALL 1-800-424-5555 48-HOURS <br /> PRIOR TO DIGGING / �J <br /> Inspection By � <br /> CALL 259-8810 FOR INSPECTION <br /> Date inspected — <br /> SEE SKETCH ATTACHED No. 28732 <br /> INSPECTION <br />