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CHART N0. <br /> ieverett <br /> � �� I <br /> � _ <br /> a H e _ _ _, .� _, _. <br /> 9 H [/� 'K - . --� t �-; b. �. A � <br /> �y <br /> �� City of Everett � � � � ' � : I <br /> � , <br /> °y� SewerApplication,�nd:�Per-mi# � :, '� � <br /> o � � No. 28237 DATE ' 4 � �� - � � - - i k; a ~ � <br /> � �g , <br /> �-Q+y � Service Address �s1��� ' Ulility Accounl No. — <br /> �x y �.�C..I� -..� 2 7�d` � �.l <br /> H y Billing Address ----r-- <br /> o y�'+ City,State, Zip �f' � f wE-lT ���2�" Permit Fee $ — I <br /> o W " � <br /> ��� Owner �� �.-��b Ft1Cl� Connectlon Charge il <br /> � L0 Connection by ��n,l P.��-f- Trunk $ _�,�;'� ' �41— <br /> Address Lateral S " � ���- j <br /> � Total Connection Charge $ % ;`� �. � <br /> � �� Phone �=��n'� Utility Development Fee <br /> Legal Description: VJater $ � � _> <br /> Lot Sewer $ ! . � � ' <br /> � �� I <br /> Block Total Development Fee $ ' ' <br /> Plat <br /> i �� Unplatted Description: Sewer Bond District ' _ <br /> _ Abutting Lot Line I <br /> �1�' _ N� S. E,W ft. � <br /> � . <br /> Typii of Permit Approved By <br /> � Remarks Issued By ' <br /> ' � __ Customer SignaWre / � <br /> IMPORTANT! <br /> CALL 1-500-424-5555 48-HOURS � <br /> PRIOR TO DIGGING <br /> Inspectlon By <br /> G''� <br /> I CALI_259-8810 FOR INS?ECTIQN <br /> Date Inspected �d ���' - �/ <br /> SEE SKETCH A7TACHED NO. �L$237 <br /> � INSP[CTION <br />