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�- . . !: <br /> � �� <br /> A <br /> � x� <br /> K � � CHART NO. <br /> y � I <br /> � �M everett <br /> �� � � `- Tn pn�T►Nf _ � <br /> o� e � <br /> �°�h �� - - -. �: - <br /> N` � Cfty of Everett - �; � _ _ - � <br /> x H� - � ... ^` :,' _: W Y:. <br /> � My �� �licat�o� �and Perm�t <br /> g�� Sewer �p�� Jw � � � �� � ' <br /> � � � � �' � � <br /> ��� NO. �S�� . DATE cnaa w } �n ,40. _ <br /> H O fn <br /> Service Address 6Q17 r�+ �*�-iel a°^ Utility Account No. <br /> Billing Address <br /> City, State,Zip <br /> p *t �� oa�ne — PermitFee $ _ 30.00 <br /> Owner Connection Charge <br /> Connection by �ti��` �"`� Trunk $ <br /> Address Lateral $ <br /> -0- <br /> Total Connection Charge � <br /> /.. : <br /> � C'� phone Utility Development Fee <br /> ; 27.00 <br /> 1 Legal Description: Water $ <br /> 71.00 <br /> ��� ' Lot --«.. L ..v T„r i z — Sewer $ <br /> ��� 9e_on <br /> Block Total Development Fee S— <br /> � '��. Plat Pinahurst ➢iv 8 � <br /> I �� Sewer Bond District $ond II <br /> Unplatted Description: <br /> � Abutting Lot Line <br /> �� N�S,E,N1 ft. <br /> 1'ype of Permit ----«+ Approved By I <br /> � � - <br /> � �� � Rematks • credit on Laes aivcn for deemliehed Issued By He�---` � i <br /> 1 � <br /> homn addressed G915 Couaerctal Ave CuslomerSignature �� � <br /> �� <br /> lo`� IMPORTAN'f! <br /> CALL 1-800-424-5555 48-HOURS <br /> PRIOR TO DIGGING ' � <br /> ������ � . <br /> Inspeclion By - � ii <br /> CALL 259-8810 FOR INSPECTION ,�/,� <br /> Date Inspecled , I <br /> SEE SKETCH ATTACHED No• 2827n � <br /> I <br /> IlidSPECTiON � <br />