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everett - CHART NO. <br /> I - <br /> :rt <br /> � <br /> City oi Everett :� � � <br /> I r Jp <br /> t;. <br />; Sewer Application ani��Permit � <br />' t� 3 r <br /> NO. Z H s s H DATE " �w = <br /> d ��y/4$ <br /> %, <br /> Service Address Utility Account No. <br /> Billing Address - nn _� c,�� <br /> i `, City, State,Zip Permit Fee $ in nn <br /> Owner <br />'i •. , — Connectlon Charge <br /> ' Connection by Trunk <br />, $ <br /> i Address __;�8 �M�� Lateral g <br /> „ Total Connection Charge $ <br />� Phone <br />' - „ Utility Development Fee <br />� Legal Description: Water g <br />', Lot Sewer g <br />� <br /> 81ock <br /> Total Development Fee $ <br /> I Plat <br /> h Unplatted Description: <br /> Sewer Bond District <br /> ' Abutting Lot Line <br /> N' S• E,W R. <br /> Type of Permit Approved By <br /> Remarks connectioa <br /> / Issued By �� <br /> _�l✓�..�r -<<.,».<-;., `7' /l w /�.-.�- � <br /> Customer Signature � <br /> r <br /> IMPORTAN'I'1 <br />� CALL 1-8O0-424-5555 48-HOURS <br /> PRIOR TO DIGGING <br /> I CALL 258-8810 FOR INSPECTION Inspection By_ �t `P/i,..�.�+ <br />' Date Inspec,ed � `�z�� <br />� <br />' i SEESKETCHATTACHED No. �S�GH � <br />', i <br />, I INSPECTION I <br /> � <br />