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�i� <br /> i CHART N0. <br />�� everett -� <br />� <br /> � <br />'' -� <br /> � <br />�' � � � Q �^ �nSTiNf � Z� t <br /> City of Everett� � « � <br /> Sevver � �ation and Permit <br /> � �� � U <br /> N0. �$ � DATE �=il s 1�1 — <br /> ; Servloe Address 15. + �+�� oe �t Utiliry Account No. <br /> � <br /> BIIIIngAddress �pi� °i"�"• a1►� <br /> i <br /> S Ciry, State,Zip �pit, M11 oY�Oi Permit Fee $ ,��so <br /> i <br /> Owner Connection Charge <br /> j . . <br /> �y Tvnk S <br /> Addresa �^��� t'� �t � Lsteral S <br /> Tntel Connection Charge $ <br /> Phone Utility Development Fee <br /> Legat Descriptlon: Water $ <br /> �t tct� 1 lbra s sewer S <br /> � Bbck �7L 1'otal Development Fee S <br /> i <br /> Plat �i.�_q *,,.��•at <br /> i <br /> Unpletted Descrlption: Sewer Bond Dlstrict <br /> Abutting Lot Line <br /> N S� E,W ft. <br /> Type of Permit Approved By <br /> � <br /> Remarka Issued By— <br /> Customer Signature <br /> � � . <br /> IMPORTANTI <br /> CALL 1-800-424-5555 48-HOURS <br /> PRIOR TO DIGGING <br /> CALL 259-8810 FOR INSPECTION �nspection ey <br /> Date Inspected <br /> SEE SKETCH ATTACHED No. Z S Z O 4 <br /> INSPECTION <br />