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CHART NO. <br /> everett ; <br /> _ o o� �' <br /> �p � �,� s � o � ��1 �1 <br /> 5� � o �tSCJ <br /> ICity of Everett <br /> Sewer Application and Permit � <br /> NO. Z$OHT DAT'E �F -30 - 9 � I <br /> � <br /> Service Address � q O 9 �.o m F�A t-� Utility Account No. <br /> Billing Address <br /> City, State, Zip Permit Fee $ I <br /> Owner Connection Charge <br /> Connection by C I �' �1 a � �ll P.�'G�"� � Trunk $ � <br /> Address Laterel $ i <br /> Total Connection Charge $ I <br /> Phune Utility Development Fee <br /> Legal Description: Water $ �i <br /> Lot Sewer $ i <br /> Block Total Development Fee $ � <br /> � <br /> Plat � <br /> I <br /> Unplatted Description: Sewer Bond District i <br /> I Abutting Lot Line i <br /> N� g, E� yy ft. <br /> Type of Permit Ri�.� a 1 � �� �i- I%� r�' �� Approved By <br /> Remarks �� � `.�' �• � � ;. � - �, , Issued By l� b ni M i � ��,- <br /> rv�.a .A l 7� � k'�� i` ( , n : _ Customer Signature <br /> � IMPORTANT! � ! �j ' IV o f �r tr � -� o ,-�� <br /> r1/I.�„�/ � v ` c� i <br /> � CALL 1-800-424-5555 48-HOURS STi 1 N U ' � � 5 ' d. <br /> PRIOR TO DIGGING S S � �/� 3 � � I <br /> CALL 259-8810 FOR INSPECTION Inspection By J � —'?�' I <br /> Date Inspected _...� � /�� I <br /> � <br /> SEE SKETCH ATfACHED No. Z S O H 7 � <br /> I <br /> � UTILITY BILLIi�JG� � <br /> i <br />