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I <br /> i <br /> I CHART N0. <br /> everett <br /> I , li! ��l�r'/: i� _ <br /> �� e ��� <br /> H�� i� � <br /> !�� <br /> �a y City of Everett <br /> �ozm <br /> 'y�' Sewer Applicat�on. and Permit <br /> H XH ' <br /> K C) <br /> H�7 <br /> yyH NO. 28512 DATE � - / '-I 9 �— <br /> � z <br /> Qy� � Service Address �' Utility Account No. <br /> O �+ ' <br /> H �g Dilling Address I <br /> r�'+� � ; Permit Fee S <br /> z f., City.Sta1e,Zip <br /> ta H y p,ti,�ef Connection Charge ' <br /> g �c~n i Connectionby ��.;'�`����-�r-"L'rt F Trunk $ II <br /> � y� 'I Address Laleral $ � <br /> �7 o v� Total Connection Charge $ �� <br /> I jl <br /> Phone Utiliry Development Fee <br /> � Legal Description: Water $ - � <br /> Ii � <br /> p Lot Sewer $ i <br /> 1��� I� Dlock Total Development Fee $_ ! <br /> i ' <br /> (,� �' I Plat <br /> „ '�' I Unplatted Description: Sewer Bond District <br /> i <br /> Abutting Lot Line i <br /> .��. � ', <br /> �� N,S.E,W g, <br /> T��pe oi Permit ��� � ��' n l.a c,¢ rl Approved By <br /> � `(� � Hemarks '•• �. � •, , Issued 8y� M+ ��n �- <br /> ,� � S � C .�,� Customer Signature - 3 �� <br /> 1�1 I �, �,. � at i►,r,.i �a 1 <br /> � IMPORTANTI <br /> �,. „� 6 � d ; <br /> �(�� i CALL1-800-424-5555 48-HOURS 55 � �J/L �/ ' C�. i <br /> i PRIOR TO DIGGING i� �' ' <br /> `J I InspeKlon By <br /> / / L e.��� <br /> CALL 259-5810 FOR INSPECTION <br /> i Date Inspected � � `� �"� I <br /> , �� <br /> � SEE SKETCH ATTACHED No. 28512 �i <br /> ' f'� <br /> U i I'_rrr 1!'.f � �r:; <br />