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W <br />City of Everett <br />SS <br />O D <br />J~ M <br />Sewer Application and Permit <br />bI U <br />NO. 28522 DATE <br />ow - <br />Service Address -- - Utility Account No. <br />Billing Address <br />City, State, Zip :.'^ •'° �'• 9�074.i�ird--- <br />Owner <br />CHART NO. <br />TO POSTING-2/Z , L <br />Permit Fee $ 10 ^^ <br />Connection Charge <br />Connection by Trunk <br />Address <br />Phone l�^ "•O — <br />Legal Description: <br />Lot <br />Block <br />Plat <br />Unplatted Description: <br />Type of Permit ""'•**� <br />Remarks <br />IMPORTANTI <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <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 />N, S, E, W <br />Approved Approved By New" <br />Issued By <br />Customer Signature <br />all <br />Inspection By — <br />Date Inspected <br />INSPECTION <br />NO. 28522 <br />