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everett �� <br />� <br />n <br />z <br />�� <br />� �i���� �; ��'�ti <br />City of Everett � ._ o �,� � � ��_ .. � <br />r`�::',"`� :`� _ '`.'o' <br />' Ni N- `� �'� Y <br />Sewer �4p�lica�ii�n�and�Per�nit <br />; n =�?%�.��;-r`: T.� <br />'.�. ` ��'`.yJ"r,x � - ���`= �` <br />-S S' .0 C> u S 1 _ .:. ?c .-! '.. <br />NO. �'% �?.i DATE � s��,n� , �, i�90 <br />Service Address ge� �� g�-g}�„ s� Utility Account No. <br />Billing Address .---��-_ <br />Ciry, State, Zip <br />Owner <br />Connection by <br />er <br />Address <br />Phone dBt-90SS <br />Legal Description: <br />Lot <br />Block <br />Plat <br />Unplatted Description: <br />Type of Permit <br />Remarks _ <br />IMPORTANT! <br />CALL 1-500-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />SEE SKETCH ATi'ACHED <br />CHART NO. <br />��f �(� �s��ti�� F-iz-9� <br />Permit Fee $ _ <br />Connection Charge <br />Trunk <br />$ �f9..... <br />Lateral $ <br />Total Connection Charge $ <br />Utility Development Fee <br />Water <br />Sewer <br />Total Development Fee <br />$ <br />Sewer Bond District _m,;,�� <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />Issued By �e��f} <br />Customer Signature <br />:e ., <br />Inspection By _ ��"� <br />Date Inspected � � —�� _ <br />IIVSPECTIOf� <br />No. 27923 <br />� <br />