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CHART N0. <br /> everett <br /> !0 P(�S�I�G_ �-��-y,� <br /> Cfty of Everett o:��,�:s;.� �::,.�,r�� �,[�r;�iu, t r�: <br /> Sewer Application and Permit ��:��» <br /> a s�ra� :��.� <br /> ItCq70?t�rt'1 <br /> �9�� �WEF 5::..'�1 <br /> NO. Z 8 6 4 7 DATE r.nh �e ,ot� - <br /> L' �tiii in.`;3 <br /> �„�,�,,� ,. , <br /> Service Address Utility Account No. --;,�.+r�:---- <br /> SEW[:F i2.'i0 <br /> Billing Address ��'�`1 <br /> C �`CI i 4�i„i0 <br /> City,State,Zip � — Fernit Fee $ <br /> Connection Charge �' �'� �''� <br /> Owner r�••,�^n - CIIEC7; a-Z.� <br /> ConnecNon by Trunk $ <br /> Address Lateral $ <br /> Total Connection Charge $ <br /> Phone Utiliry Development Feo <br /> Legal Description: Water $ <br /> �t Sewer $ <br /> B�� Total Development Fee $ <br /> Plat <br /> Unplatted Description: Sewer Bond District <br /> Abutting Lot Line <br /> NSEW ft. <br /> Type of Permit CasrDa — Approved By <br /> Remarics Issued By <br /> Customer Slgnature <br /> IMPORTANT! ��� r <br /> �r� � <br /> , CALL 1-800-424-5555 48-HOURS ;�,� ��6 <br /> PRIOR TO DIGGING <br /> Inspection By. <br /> CALL 259-8810 FOR INSPECTION <br /> Date Inspected <br /> SEE SKETCH ATTACHED No' 28�47 <br /> INSPECTION I <br />