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CHART NO. <br /> I everett 1_ I <br /> � <br /> .5e,�r-i- � �as�,�_y G-c�' -4i <br /> �:, <br /> � <br /> City of Everett� � �; � <br /> .t <br /> Sewer Ap;���ation and Permit <br /> . '� • . J r... <br /> ra rT�t � �� 34.' <br /> '�, F � L•" .1'` <br /> N0. �a�g2 ` � DATE M.�,�, , ,00, <br /> Service Address ���4 &g sverott Fta�� 5�aq--- Utiliry Account No. ( <br /> Billing Address " " " <br /> City, State, Zip ��t!, wn 96204 Permit Fee $ 10.00 _ <br /> Owner 6eaf+rat t��k Connection Charge <br /> Connection by �tt const. Co. Trunk $ -- <br /> Address �ao� unPharven ua_ _ Lateral $ - <br /> .,.,•..,.«.... ..,� g�i3 Total Connection Charge $ <br /> Phone 653-3133 Utility Development Fee <br /> Legal Descriotion: Water $ _ <br /> Lot Sewer $ ( <br /> Block Total Deveiopment Fee $ <br /> Plat I <br /> Unplatted Description: Sewer Bond District — <br /> Abutting Lot Line I <br /> I <br /> N, g, E, W — ft. � <br /> Type of Permii �pnTo Approved By <br /> Hemarks Issued By <br /> Customer Signature <br /> IMPORTANT! <br /> CALL 1-800-424-5555 48-fiOURS <br /> PRIOR TO DIGGING � <br /> CAL.L 259-8810 FOR INSPECTION Inspection ey <br /> � <br /> Date Inspected s � � G <br /> SEE SKETCH ATTACHED NO. �S Z H 7 <br /> INSPECTION <br />