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everett CHART N0. <br /> City of Everott oerze.�vi io�oeai 000aNeba� trRx <br /> do0o¢7339 <br /> Sewer Application and Permit � <br /> � � <br /> � <br /> NQ. �8404 DATE ,•..;• a�, 1sa � <br /> c� w.00 <br /> Service Address Utility Account No. <br /> Billing Addresa b � ��� � �–n — <br /> City,State.ZIP ��1'. ta r»hit07 Permit Pee S ]0.00 <br /> Owner ��p, Connectlon Charge <br /> Connectlon by Trunk : __ <br /> Address Lsteral = <br /> Totel Connectbn Cherpe S 0 <br /> Phone 1�1–St7e Utlliry Development Fee <br /> Legal Doscrlption: Water S n_7�a_is <br /> �► Sewer S <br /> Block Total DevelopmeM Fee S - �{��,» <br /> Plat <br /> Unplaped Deacrlption: Sewer Bond DleMct <br /> Abuttinp Lot Line <br /> N, S,E,W k, <br /> Type of Permit Ilw mes�atis Approved By <br /> Rematka Isaued By.��� <br /> Customer Signature ' <br /> IMPORTANT! <br /> CALL 1-800-424-5555 48-HOURS <br /> PRIOR TO DIGGING <br /> G� ,. , <br />' CALL 2bY-8810 FOR INSPECTION Inspectbn By <br /> Date Inspected <br /> SEE SKETCH ATTACHED No. 28404 <br /> iNSPEcnoN <br />