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everett <br />,� <br />:-� <br />� <br />�, � - <br />� _ �;� �� �s�s <br />City of Everett t, �, .- -• � � : _ = � � <br />� .7 �,c `' w. f l <br />p . <br />Sewer App�lica�i�c�'i �nc� Permit <br />��� y r� � cc '- G �'�. <br />� .r .. i� ti �: �'S ��1 4d <br />xz � �'.��.- �'`J—,`-- �J = c-' <br />N0. 2� 6� g �' DATE Peb. 14. 1992 <br />Service Address 9815 Lv�rsraan Ha� <br />Billing Address 9815 Evertreon fi�y <br />City, State, Zip ��rett ilA 95203 <br />Owner �°m �A16° <br />Connectlon by <br />Address <br />Phone <br />Legal Description: <br />Lot <br />Block — <br />Plat <br />Unplatted Description: <br />Type of Permit n�v conn�ction _ <br />Remarks <br />i!1APORTANT! <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Utility Account No. <br />CHART NO. '� <br />x ►3 �a�`l Sti/ <br />�� ?OSTING �"= <br />PermitFee $ 30.00 <br />Connection Charge <br />Trunk <br />� <br />Lateral $ <br />Total Connection Charge $ <br />Utiliry Development Fee <br />Water <br />Sewer <br />Total Development Fee <br />Sewer Bond District <br />Abutting Lot Line <br />N,S,E,W <br />$ 14�.55 <br />$ 378.45 <br />$ 522.06 <br />Approved By <br />Issued By A°�°� <br />/ <br />Customer Signature � <br />. - . i -�/_��/ � <br />i � <br />i. • .- :. � <br />INSPECTION <br />No. 28fs09 <br />n. <br />