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everett <br />Le <br />City of Everett <br />Sewer Application andUPe t <br />NO. 28378 DATE ttuon. 12- 1") <br />Service Address Inn+ r ry.4.o ita 311,49 40-04 Utility Account No. <br />Billing Address <br />City, State, Zip s.acei. v>, 98 �a Permit Fee $ <br />Owner 22M Relay pp Connection Charge <br />Connection by owTrunk <br />Address <br />Phone <br />Legal Description: <br />Lot <br />Block <br />Plat <br />Unplatted Description: <br />Type of Permit ,r=pxx ry <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 />nil <br />Lateral <br />Total Connection Charge <br />Utility Development Fee <br />Water <br />Sewer <br />Total Development Fee <br />Sewer Bond District <br />Abutting Lot Line <br />$ 335.16 <br />$ 335.16 <br />N, S. E, W ft. <br />Approved By <br />Issued By a Rockwall <br />1 Y <br />Customer Signature <br />Inspection By 93 <br />Date In —acted <br />4 <br />INSPECTION <br />No. 28378 <br />