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everett <br />City of Everett <br />Sewer Applicatioc� and Permit <br />NO. 2$722 DATE <br />Servfce Address �'•Q ���¢aL��•.�_ Utiliry Account No. <br />Billing Address —t:_ e� _^� � -�y�— <br />Ciry, State, Zip Permit Fee $ <br />Owner Connection Charge <br />� wn <br />Connection by <br />Address <br />Phone <br />Legai Description: <br />Lot <br />Block <br />Flat <br />Unplatted Uescription: <br />Type of Permit <br />Remarks <br />IMPORTANT! <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 258-8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Trunk <br />Lateral <br />CHART NO. <br />TO POSTING 5-� <br />tl;/15/^2 12=34PFt QCk�1Y�F3b:t Ktk3 <br />! <br />� <br />�_�, ��� ��. , <br />�000�,s;ro <br />itLDG ?135.Cm <br />PIFl �5.00 <br />J. <br />6 SRCH �4.`i0 <br />51Et�� ir?rr7.:'5 <br />Total Connectior ;harge <br />Utiiity Developmei�t ��e <br />Water <br />Sewer <br />Total Development Fee <br />Sewer 6ond �7istrict <br />Abutting Lot Line <br />N, S, E, W _ <br />Approved By <br />$ <br />$ <br />$ <br />Issued By <br />/.' _,�,.=:,' <br />Customer Signature ' " <br />// �S/Jc�G�-4/" <br />Inspection By /`� � �� �i� <br />Date Inspected �- I z <br />INSPECTION <br />NO. Z87'L2 <br />n. <br />