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� . <br /> ; ;� <br /> � <br /> � �tl CHART NO. <br /> ,��� everett <br /> u <br /> y�� � IO POSTING s i� z <br /> ��� <br /> u CityotEverett ��; �x: ^:� :_:,wF�i �bx4.�:-rr;�� ;; . . <br /> ��� ' <br /> � Sewer Application and Permit � ��o.� - <br /> ��� ���, s�o.� <br /> � <br /> �H� � NO. Z$ss4 DATE n��:ii z, xasz <br /> u � • <br /> �+ Service Address �ggg.�}� Utility Accoun[No. <br /> � � Billing Address —20o5-Colka.ntrc. <br /> �� City,State, Z�p ��mti 98�9� Permit Fee $ i n_no <br /> f Owner ec_ p.,,i rn,r� u„r�,�, tar pr�•.� ConnectionCharqe <br /> Connection by �,.� Tmnk $ � <br /> Address Lateral $ <br /> Total Connection Charge $ � <br /> , Phone Utility Development Fee <br /> I �� Legal Description: Water $ <br /> � ' Lot Sewer $ <br /> � �� <br /> L�� Block Total Developmenl Fee $ <br /> Plat <br /> J 1�=' Unplaried Description: Sewer Bond District <br /> I7��� <br /> Aburiing Lot Line <br /> ' N,S, F,W ft. <br /> �o� � <br /> Type of Permit xsrnacxr:ex �rrreR�rrcn� Approved By <br /> Remarks Issued By J tao�k.rell I <br /> �'`� Customer Signature � <br /> � IMPORTbNTI <br /> � '� <br /> _� CALL1-800-424-5555 48-HOURS <br /> PRIOR 'i'O DIGGING � <br /> Inspectlon B��—��„*�' — <br /> CALL 259•8810 FOR INSPECTION <br /> Date Inspected � Z-`�Z <br /> SEESKETCHAITACHED NO. LBSGG <br /> INSPECTION <br />