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� . <br /> - - C�ART NO. � <br /> ; , <br /> � „ everett � <br /> � � <br /> � y e _ <br /> � _ _ _ _ _ �� ,�p�, <br /> o � City of Everett:_ _ t _ � <br /> ro � N _ .� .:. : ��//G�S� <br /> o � � Sewer Qp�lf+ca�ion and Permit <br /> � � � � :� � _ � �, :� - - <br /> H � � �^ �2 � �� � J � � <br /> � y NO. �� '�� -- DATE � <br /> M <br /> � o N Service Address Utility Account No. <br /> � � y Billing Address <br /> y Permit Fee $ io �� <br /> City,State,Zip - <br /> Owner , Connection Charge <br /> Connection by Trunk � <br /> Address Lateral $ <br /> � Tolal Connection Charge $_ <br /> � Phone - Utility Development Fee <br /> , Legal Description: Water $ <br /> �C� � Lot Sewer $ <br /> J : Block Total Development Fee S <br /> 1 <br /> � �'��' Plat <br /> �� -- <br /> I Unplatted Description: Sewer Bond District <br /> � Abutting Lot Line <br /> I ��� <br /> � N� S, E,N1 ft. <br /> Type of Permit Approved By <br /> i1� , Y <br /> � Remarks Issued B . , <br /> � ��eG �.� <br /> n 1 �1J � �/ Customer Signature <br /> + y�� . IMPORTANTI <br /> � � CALL 1-800-424-5555 48-HOURS <br /> I (_1- PRIOR TO DIGGING <br /> \ Inspection By <br /> CALL 259-8810 FOR INSPECTION <br /> Date Inspected <br /> SEE SKETCH ATTACHED No. 28117 <br /> INSPLCTICP� i <br />� _ � <br />