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i <br /> � <br /> CHART NO. <br /> everett <br /> <a �os��,1� <br /> City of Everett l �/9��/ <br /> Sewer Application and Permit <br /> N�. 2 8 3 5 7 DATE _T+.. �a +ee� <br /> Service Address lola a�ll,,r �.r. Utility Account No. <br /> Billing Address ' <br /> City, State,Zip Permit Fee $ �0 <br /> . <br /> Owner �� �� Connection Charge <br /> Connection by Trunk $ <br /> Address Lateral $ <br /> Total Connection Charge $ <br /> Phone Utility Development Fee �� � ""t 11=21�dti 000riqG'�e"� t��� <br /> Legal Description: Water ����5�'4 <br /> (x.fN� ;.4,� <br /> Lot Sewer I: �ZI! 44.'�1 <br /> :RO[IQ2P•Z:�� <br /> Block Total Development Fee!�I�1 i���_tn —. <br /> (]�I'fl; 410i.�;� <br /> Plat <br /> Unplatted Description: Sewer Bond District <br /> Abutting Lot Line <br /> N, S, E,VV h• <br /> Type of Permit .��....e,.e Approved By— <br /> Remarks Issued By � �ri+u <br /> Customer Signature � <br /> IMPORTANTI � ��,� <br /> �`9 5/�PC O <br /> CALL 1-800-424-5555 48-HOURS a � a� �t �° �``5�� <br /> PRIOR TO DIGGING o� ' <br /> CALL 259•8810 FOR INSPECTION Inspection By <br /> Date Inspected <br /> SEE SKETCH ATTACHED No. 28357 <br /> INSPECTION <br /> � <br /> �M� <br />