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. � C"4RT N�O. <br /> everett <br /> City of Everett n3,�lsi� s:�aen nooaa�eao sxts <br /> i <br /> Sewer Application and Permit �z9 =4.� <br /> �::� <br /> � ' z�.� <br /> NO• Z$G 4 G DATE ;rooa;�a <br /> . . . . <br /> 90o0�e6ib <br /> $ervipe Address =na n,�w��� Utility Account No. SEi� t� 50 <br /> FID0036021 <br /> BflBrq Address 3?9� 11�de:��ur .r-- B Sf�}i l4.50 <br /> SIOOQ36Q�� <br /> Ciry'� State,Z1P � Pertnit Fee S �:5� 5F�1 �fr.59 - <br /> ��� ""'_"^ SerC Connection Charge a�a' �•� <br /> Connect(on by ��a Trunk S <br /> �aa� �ce�ai a <br /> Total Connectbn Charye S <br /> Phone UtIIRy Development Fee <br /> ����P��� Water S <br /> �ot sewe� a <br /> B� Total DevelopmeM Fee S <br /> Plat <br /> Unplatted DascripNon: Sewer Bcnd Oistrict <br /> _ Abutting Lot Une <br /> N,S, E, W fc. <br /> Typ�ot Pertnit r�s�.. Approved By <br /> Remarks Issued By J lbeb+u <br /> Customer Signature <br /> IMPORTANT! <br /> CALL 1-B00-424-5555 48-HOURS <br /> PRIOR TO DIGGING <br /> CALL 269-8810 FOR INSPEC710N Inspection By <br /> Date Inspected <br /> SEE SKETCH ATTACHED No. �LH646 <br /> iNSP=_crior� .,,,,,�.,�.,..� <br />