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t7 l'�� y <br />m�s <br />r ."yC y <br />y z r��+ <br />� �� <br />"t] H'� <br />V1 H <br />� O t+] <br />y t7 <br />� �� <br />c� � oq <br />9 H [�7 <br />r z <br />hi H <br />C �n <br />O H <br />c� G [n <br />��� <br />H O fyn <br />�� e.. <br />�.,, � <br />l.p, s. <br />r � <br />�c a <br />d`_" 1 <br />.e._ �„ <br />A <br />�� <br />CHART NO. <br />everett <br />- -,- - -._ <br />_ _ _ _; ^ r: <br />�ity of Everett - �� �,. �` � � _ <br />=; _� . : ,,.: <br />. K �: .� . .f. <br />'! rr «+ <br />Sew�:� Ap�lecaiion �ridwf�e�mit � � <br />� _ � <br />i c _ <br />a � w �' � <br />No. 28546 UATE _nacems�r iy�_1391 <br />Service Address di � * � -� " �i o^ ^* - <br />Billing Address — <br />City, State, Zip —�Y <br />Owner �_ _ <br />Connection hy <br />Address <br />Phone �s� »�� — <br />Legal Description: <br />Lot <br />Block <br />Plat <br />Unplatled Description: <br />Type o( Permit ritsFt cotrvECt'zOtt <br />Remarks <br />IMPORTANT! <br />CALL 1-800-42�3-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8610 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Utili;y Account No. <br />Perm3 Fee $ <br />Connection Charge <br />:� 7'n n�cl'Iti�� �;� _� <br />i: _ <br />Trunk ' <br />Lateral <br />Total Connection Charge <br />Utility Development Fee <br />Water <br />Sewer <br />Total Development Fee <br />$ <br />$ <br />$ <br />$ ��� nn <br />$ Ga8.00 _ <br />$ oe4 �n <br />Sewer Bond District I �''{ `� <br />Abutting Lot Line <br />N, S, E. W — tt. <br />Approved By <br />Issued �y <br />Cuslomer Signature <br />Inspection Ry �� �OCJ' ` <br />Date Inspected �''� - �' 1' <br />IiJSP6CTION <br />No.285�6 <br />