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everett �- CHART N0. _ <br /> � <br /> a <br /> r <br /> _, <br /> City of Everett s � � <br /> ,:, o 0 <br /> .. «. ,. <br /> Sewrer Application ar���ermit <br /> � f 1 " <br /> i> <br /> d � <br /> NO. 27986 DAl'E � 6 � " <br /> ..GeLn1�r �7 1090 <br /> Service Address Utilit�Account No. <br /> Bill(ng Address �� <br /> Ciry, State,Zip —__....�r�^T�O� Permit Fee <br /> $ 10.00 <br /> Owner <br /> Connection Charge <br /> Connection by Trunk <br /> $ <br /> Address _ ?�911 ,� 9s Lateral <br /> $ <br /> Total Connection Charge $ <br /> Phone _ Utiliry Development Fee <br /> Legal Description: Water <br /> $ <br /> Lot <br /> Sewer g__ <br /> Block <br /> — Total Development Fee $ <br /> Piat — <br /> Unplatted Description: Sewer Bond District <br /> Abutting Lot Line <br /> N,S, E, W <br /> Type of Permit �r � ltcr- A roved B � <br /> p PP Y <br /> Remarks.[�i�v. ,o �� �ta7� w/ <br /> i , Iss�ed By <br /> _ y',ovc ,' , <br /> i ; , <br /> Customer Signature._ / <br /> IMPORTANT! <br /> CALL 1-800-424-5555 48-HOURS <br /> PRIOR TO DIGGING <br /> CALL 259-8810 FOR INSPECTION Inspection ey�'-� <br /> Date Inspected /� io iU <br /> SEE SKETCH ATTACHED NO. Z7�$� <br /> INSPECTION <br />