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, .- <.`;,_ ' , --_ CHART NO. -- <br /> everett ', <br /> � � M <br /> � � � � <br /> b � � I � I <br /> C N � <br /> H <br /> K � � City of Everett �I <br /> V y � <br /> � � � Seonrer Application and Permit ��%`��;c=�! ) <br /> � <br /> I ;. �I <br /> " � � Na28505 DATE hr� r� G -4 � �� � + <br /> Z y � j <br /> i <br /> � '" y I Service Address �� �� g /� o r+� b Fl r C� ��t'- Utiliry Account No. <br /> i <br /> o �' � I <br /> (] C N I i <br /> � � r i Billing Address i <br /> ea <br /> y o v`�i �I City, State,Zip Permit Fee $ , <br /> Owner Connection Charge i <br /> i � <br /> IConnectionby � �.�,+s�� F6!`� ret� Trunk $ <br /> � Address Lateral $ <br /> II Total Co�nection Charge $_ ' <br /> I <br /> Phone Utility Development Fee <br /> Legal Description: Water $ <br /> i `�.,� , Lot Sewer $ <br /> �� I Block Total Development Fee $ <br /> I '� <br /> �I i Plat <br /> !�� <br /> i Unplatted Description: Sewer Bond District <br /> Abutting Lot Line <br /> i <br /> �� �, N� S. E�W ft. <br /> I �,� ' <br /> Type of Fermit p��� .� 'r�l�� � � Approved By <br /> p ,y�' Remarks S d p c o b,)o (� I /� Issued By�1gL,f /�� ���-r' <br /> � <br /> �T�-, -{-��6�/1 � �c i �/ CustomerSignalure <br /> � � P�� ' IMPORTANT! �� ��`'� � d��P <br /> �+� i c . p . .S � d QC P � �/C� ! <br /> � CALL 1-800-424-5555 48-HOURS J-S `-'� �—�� �� 3 3 d <br /> �� PRIOR TO DIGGING �3� � S a�' /j1/� C_ <br /> � ��� Inspectian By �--i.-� <br /> � CALL 259-8810 FOR INSPECTION <br /> Date Inspected �" -1�- '�/ � <br /> i SEE SKETCH ATTACHED No. 28505 <br /> � <br /> � <br /> ; i_!rn_rr� , i.;_� <br />