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, <br /> everett L CHART NO. <br /> r I <br /> :1 <br /> �� � U ��G 5 ��rt�7 <br /> � <br /> City of Everett x � � /0% �/�� <br /> .� ;; <br /> Sewer A�p�lication and Permit <br /> � „ _ <br /> �� � � � <br /> � w <br /> NO. �� 'J V <br /> �4 DAT'E �.,,.t, �a, ,anl <br /> Se�vice Address _ }����� Utility Account No. _ <br /> Billing Address <br /> City, Sta'e, Zip �e�tr� mn ga2n1 Permit Fee $ _ lQ.�p <br /> Owner ��4q}s���yM�es Connection Charge <br /> Coni;ection by _ei��e Trunk $ <br /> Address Lateral $ <br /> Total Connection Charge $ <br /> Phone ��_ Utility Development Fee <br /> Legal Description: Water $ <br /> Lot <br /> Sewer $ <br /> Block Total Development Fee $ <br /> Plat <br /> Unplatted Description: Sewer Bond District <br /> — Abutting Lot Line <br /> N, S, E, W h <br /> Type of Permit _ ��y�.�� <br /> Approved By <br /> Remarks N Issued By .T w+�i-,.,,,ii <br /> � allK h��� � <br /> � ,�'�—�e p°�CustomerSignalure <br /> IMPORTANT! <br /> CALL 7-800-424-5555 48-HOURS <br /> PRIOR TO [�IGGING <br /> CALL 259-8810 FOR INSPECTION Inspection By <br /> Date Inspected <br /> SEE SKETCH ATTACHED N0. 2 E�2�� <br /> INSPECTION <br /> I <br />