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i <br /> everett <br /> CHART N0. <br /> _� <br /> City of Everett <br /> Sewer Application and Permit <br /> NO. 2 H O 7 O DATE l -.3 l-Ql <br /> Service Address 1 St 2 �,b w. !a r c� Utility Account No. <br /> Biliing Address <br /> City, State, Zip Permit Fee $ <br /> Owner Connection Charge <br /> Connection by Trunk $ <br /> Address Lateral $ <br /> Total Connection Charge $ <br /> Phone Utility Development Fee <br /> Legal Description: Water $ <br /> Lot Sewer <br /> $ <br /> Block Total Development Fee $ <br /> Plat <br /> Unpiatted Description: Sewer Hond District <br /> _ Abutting Lot Line <br /> N� S� E� W fl. <br /> Type of Permit ��/a /y- Approved By <br /> Remarks �� ^� n�" :�:u�' Issued By �nnr Mi ( �N_r <br /> r� 64� �� � � U # � <br /> Customer Signature <br /> IMPORTANT! <br /> CALL 1-800-424-5555 48-HOURS <br /> PRIOR TO DIGGING <br /> CALL 259-8810 FOR INSPECTION Inspection By <br /> Date Inspected _ <br /> SEE SKETCH ATTACHED No. 2 8 O 7 O <br /> CUSTCMER COPY <br />