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everett <br />,e r• <br />M <br />N <br />City of Everett _� $ <br />M M <br />Sewer April', ation and Permit <br />NO. 313 DATE _ JUne 14, 1991 <br />Service Address <br />Billing Address " <br />City, State, Zip tipye&%, *A ygiO4 <br />Owner ofting ft. <br />Connection by 1luburn llechaeical <br />Address 36y M. ihiiey-Mghway <br />Phone 838-9780 <br />Legal Description: <br />Lot <br />Block _ <br />Plat <br />Unplatted Description: <br />Type of Permit NEW COMCP10A <br />Remarks tiehak up Gff4c&- Qnssnct Inn <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 />Utility Account No. <br />r'rART NO. <br />Permit Fee $ — 30.00 <br />Connection Charge <br />Trunk <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 />p03J,.t I <br />� -6 --cl/ <br />N, S. E, W ft. <br />Approved By <br />IcRued By * 211 .1rI I <br />Customer Signature <br />Inspection By <br />Date Inspected <br />INSPECTION <br />No. 28313 <br />