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CHART NO. <br /> everett <br /> �n ��rc�rit�G � - �9-�y <br /> City of Everett o3�ie;vz SLr�,��n oaonu�x+ <<�1 <br /> r <br /> Sewer Application and Permit ��°`� �4�� <br /> a()I.;Q:H(1'f i <br /> i���7 Z�.� <br /> NO. 2$6 4 6 DATE xrnm,�.���v <br /> . - <br /> s�xx4+�;:�h <br /> Service Address ?'ne r��*� a. Utility Account No. '� �'-`�----- <br /> Skllkl;.6Cl�1 <br /> Billing Address , G �Gfl! '�ti.:� <br /> 1kX�36D'? <br /> City, State,Zip Permit Fee $ , - <br /> Owner *��� *�` Connection Charge ��r' ���'� <br /> Connection by �� Trunk $ <br /> Address Lateral S <br /> Total Connection Charge $ <br /> Phone Utiiity Development Fee <br /> Legal Oescription: Water $ <br /> �t Se�ver S <br /> B�� Total Development Fee $ <br /> Plat <br /> Unplatted Description: Sewer Bond District <br /> Abutting Lot Line <br /> N, S, E,W h• <br /> Type of Pertnit M-- Approved By <br /> Remarks Issued By J te�ckv�l�-- <br /> Customer Signatura <br /> IMPORTANT! �\ ��Q��p��1 <br /> CALL 1-800-424-5555 48-HOURS �to � � �zU <br /> PRIOR TO DIGGING ` <br /> Inspection By <br /> CALL 259-8810 FOR INSPECTION <br /> Uate Inspected <br /> SEE SKETCH ATTACHED No. 256�.6 <br /> INSPECTION <br /> J <br />