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-�, <br /> �r:�=�w ;>,:. <br /> � <br /> CHART N0. <br /> �� <br /> everett , I <br /> /� 6 � `'� ; fr <br /> C�1�-�•� � ��O '"(�� (J �U � i�,'.��� <J��-r�l . <br /> [�J � U/ 0 <br /> �H � � �e °� <br /> q y y City of Everett �'I s' f; ,; /� <br /> ��_ <br /> y �~ Sewer Application and Permit <br /> � H� <br /> O x0 <br /> '� H'iJ <br /> � o� NO. Z$O89 DATE s - � 9 - 9 I <br /> O Hd <br /> H �r� Servioe Address -�� �g F r i D A�i Utiliry Account No. <br /> H� � I Billing Address �, <br /> zH � <br /> r �y City,State,Zip Permil Fee $ � <br /> g d y I owner <br /> Connection Charge I <br /> � �� I Connection by � f�1 O F U� YF 1�. Trunk $ I <br /> H o ti Address Lateral $ I <br /> Total Connection Charge $ , <br /> , 1 <br /> I� Phone ' Utiliry Developmerrt Fee ! <br /> I $ ,� <br /> � Legal Description: Water <br /> i <br /> �,�1 Lot Sewer $ ' <br /> Block ' Total Development Fee $ j <br /> �.v ,�� Piat � " I <br /> Sewer Bond District � <br /> i Unplatted Descriptiorr. � <br /> I � � Abutting Lot Line I <br /> N,S, E,W �' <br /> ��^� � Type of Permit ��; ;- /l�Ar �l Approved By � <br /> � c�CC cn o� �FQ n^,a . -� IssuedBy � - "" �� ��e�' j <br /> �� Remarks $� � <br /> _., ,�, i � L, CustomerSlgnaWre ! <br /> � <br /> IMPORTANT! M�'�" � ( ' �R� I <br /> � �� 5,-,��..� p .ra �� deep <br /> ; @ p�� � ' de�p <br /> � CALL 1-800-424-5555 48-HOURS S� 5 <br /> , , I PRIORTODIGGING 4f(P� S , o, M�-� �° Cf�RS� ST" I <br /> � Inspection By <br /> ! CALL 259-8810 FOR INSPECTION 9� I <br /> I Date Inspected l " � I <br /> I I <br /> � SEE SKETCH ATTACHED No. 28089 I <br /> IUTII_ITY BILLING ' <br />