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everett <br />City of Everett <br />CHART NO. <br />T^ �nSTING S—�_=-` <br />Sewer Applicatior� and Permit <br />NO. Z$ 3 9 Z DATE g-2i-91 — <br />Service Address �910 Dotiz� Utility Account No. <br />Billing Address —4910 DedLS� �u1► a1�roQ� <br />CRy, State, Zip ��c �u oe7e+ Permit Fee $ 30 00 <br />�8f �.�w — Connection :;harge <br />Connection by �, <br />Address — <br />Phone ,« •�+, — <br />Lepel Description: <br />Lot .10!_�'�=—' �..w�. — <br />Blodc <br />Plat <br />Unplatted Desc�iption: <br />Type of Permit t�11 ry1��.`rtm <br />Remarks <br />IMPORTANT! <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Trunk <br />Lateral <br />Total Connection Charge <br />Utiliry Development Fee <br />Water <br />sewer <br />Total Development Fee <br />Sewer Bond District � <br />a <br />a <br />$ <br />$ 22t.00 _ <br />g — - toameif <br />g �2a o0 <br />Abutting Lot Line <br />N, S, E, W n. <br />Approved By <br />Issued By � <br />Customer Signature , ' � l'� <br />inspection By _ <br />Date Inspected <br />INSPECTION <br />L�� <br />-qL <br />No.28392 <br />