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- I <br /> I <br />,. _, � CHART NO. <br /> , everett <br />�' <br />�.. <br />� o � ,. <br /> �,� ,; , � �`� �. ��� o <br /> City of Everett GL�� ��'�� <br /> Sewer Application and Permit <br /> < NO. 2 H O 7 H DATE .,z�- 1 5'� I <br />�s� <br /> '�� Service Address 3�O (� f'^r 1 p ��� Utility Account No. I <br /> Billing Address <br /> II <br /> City, State,Zip — Permit Fee $ li <br /> Owner Connection Charge <br /> Connection by G r f�l C9 t- ��J(,' NP�� Trunk $ <br /> Address Lateral $ <br /> Total Connection Charge $ <br /> Phone Utiliq�Development Fee I <br /> Legal Description: Water $ I <br /> Lot Se�ver $ � <br /> Block Total Development Fee $ I <br /> Plat <br /> Unplatted Description: Sewer Bond District <br /> Abutting Lot Line <br /> N,S, E,W n• <br /> Type of Permit i-�.c ✓'����A v Approved By <br /> Remarks ,�.1 �n S �� ���"^ Issued By �' N Mi � ��P Y <br /> p(ZpQ [��/Q v e 2 �� ;' Customer Signature <br /> r Pv� � IMPORTANT! <br /> CALL 1-800-424-5555 48-HOURS <br /> PRIOR TO DIGGING � I <br /> CALL 259-8810 FOR INSPECTION Inspectiou By i _`�e <br /> Date Inspected �—� �� <br /> � . <br /> SEE SKETCH ATTACHED No. 2 8 O 7 8 ' fi: <br /> CUSTOMER COPY <br /> � <br /> i <br />