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everett <br />City of Everett <br />TO POSTING__�-� <br />� <br />� <br />_ �:�r.��� �P; <br />„ <br />:X ��. .-i .-i ry� �t n� o� <br />.� o: c�� >., .s -t •,. <br />F': e.� i � ..� �'v <br />� •i <br />Sewer A�plication an�d.�eri�i#�.� <br />� .� ..� �r ?i.l i> <br />N 2 <br />� �'� �� � �� = 0`5 '� t_ <br />^ '� W � � �. — � ? <br />NO. 2$ �,�i 7 DATE u=�'►-90 � M <br />Service Address <br />Billing Address —�-. <br />City, State, Zfp 3626 156th St. S.o. <br />Ljna . wa+ <br />Ownpi <br />Connection by <br />Address <br />Phone <br />Legal Description: <br />Lot <br />Block <br />Plat <br />Unplatted Description: <br />Type of Permit <br />Remarks <br />IMPORTANT! <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />SEE SKETCH ATrACHED <br />Utility Account No. <br />CHART NO. <br />Permit Fee $ . <br />Connection Charge <br />Trunk <br />$ <br />Lateral $ <br />Total Connection Charge $ <br />Utility Development Fee <br />Water <br />Sewer <br />Total Development Fee <br />Sewer Bond District — <br />Abutting Lot Line <br />$ <br />.,. <br />N, S� E� W }95:53! -� ft. <br />Approved By <br />Issued By <br />i� <br />CustomerSignature G� '� `� �� ��� <br />Inspection By " /lQ�e �'Y � W . ! 45/��� <br />Date Inspected C��� �vG�i�.� //�fj�ec�+i <br />{�i��ed Car� v� <br />INSPECTION <br />No. 28057 <br />