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� <br /> CHART NO. <br /> everett <br /> � TO POSiItdG �� ' <br /> CltyofEverett-� `� �' � r ' � V R� � � �� � <br /> - Y ; ` = "�:; :- uN <br /> ;, � .. - <br /> Sewer Application���ndrP�rmit <br /> _ �-: _ - _ , � = _ n == - - _ <br /> r - : <br /> NO. �3�?� ^ DATE� � n-i�-oi � _ <br /> Service Address 5917 � e w ci.....�..e Utility Account No. <br /> BIIIingAddress tp�� � rs+•�� <br /> Ciry,State,Zip ���„+�+ Permi�Fee $ ]O.oO <br /> Owner ���A ��- __— ConnectionCharge <br /> Conneclion by ��. Trunk S �Q� <br /> Address Lateral S »� <br /> ITotal Connedion Charge S �ZS <br /> Phone ���_ Utility Development Fee <br /> Legal Description: Water $ x1 <br /> La� she�r� a1a� ila_on Sewer a 6� <br /> Block Total Development Fee $ 0�9 <br /> Plat <br /> Unpletted Description: Sewer Bond Disirict *** <br /> Abutting Lot Llne <br /> N,S,E,W ft. <br /> Type ol Permit x8w ctxnacrxori Approved By . <br /> Remarks Issued By � tr�•qh�,�• — <br /> Customer Signature <br /> � IMPORTANT! <br /> � <br /> CALL 1-800-424-5555 48-HOURS <br /> PRIOR TO DIGGING � �j <br /> I CALL 259•8810 FOR INSPECTION Inspedion ey-%"�� � <br /> IDate Inspected y ��->> <br /> SEE SKETCH ATTACHED No. 28385 <br /> i INSPECTION <br />