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0 <br />CHART NO. <br />everett <br />� <br />G? <br />�: <br />- p <br />Z ' �.'1 <br />City of Evarett `` ,;; � <br />r�. <br />Sewer ��pplication and Per�n� �i � <br />. o G r_, u <br />�"�cw <br />... iu -•- � - <br />NO. Z��J 4,. DATE .,e �.,.ti..,r i c �. �aoiY <br />Service Address " '""' �' n4a � — <br />Billing Address — <br />City, State, Zip , <br />Owner — , <br />Connection by o�er <br />Address <br />Phone �5�—Rd27 <br />Legal Description: <br />Lot _ <br />Block — <br />Plat <br />Unplatted Description: <br />Type of Permit <br />Remarks <br />IMPOR'1'ANT! <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL :59-8810 FOR lNSPECTION <br />SEE SKETCH ATTACIIED <br />Utility Account No. <br />Permit Fee $ <br />Connection Charge <br />Trunk <br />TO POSTING._ � Z' Z <br />Lateral <br />Total Connection Charge <br />Utility Development Fee <br />Water <br />Sewer <br />Total Development Fee <br />Sewer Bond District <br />Abutting Lot Line <br />N,S�E�W ft. <br />Approved By <br />Issued By <br />Customer Signature <br />Inspection By <br />'� � <br />Date Inspected � z � <br />INSPECTIOW <br />No. 28541 <br />