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xr� <br />x <br />9xH>rH/� <br />17] H <br />yx�C <br />C O� <br />OHO <br />WOE <br />c� o <br />aHz <br />~Hy <br />C7 fA <br />O H <br />0 t7 rn <br />t7 <br />z y rn <br />y o rn <br />M,^,HART NO. <br />0"ewep Application and Permit <br />r 39 G 5 DATE 9/9/92 <br />Service Address 623 Madison St Utility Account No. <br />Billing Address _ 21611 XX 45th Ave SE <br />City, State, Zip Bothell 11A 98021 Permit Fee $ <br />Owner Withers const. Inc <br />Connection by -- -k R L x c�ce ✓ . <br />Address <br />Phone <br />Legal Description: <br />A Lot <br />�d <br />Block <br />1� +� Plat <br />TO POSTING <br />Connection Charge <br />Trunk $ <br />Lateral $ <br />Total Connection Charge $ <br />Utility Development Fee <br />Water $ <br />Sewer $ <br />Total Development Fee $ <br />70.00 <br />0.00 <br />179.0') <br />471.00 <br />650.00 <br />Unplatted Description: <br />Sewer Bond District <br />Abutting Lot Line <br />N,SEW <br />ft. <br />"- <br />1 <br />Type of Permit' New connection <br />Approved By <br />q <br />Remarks Water service sold 2/18/92 — <br />Issued By <br />% CB <br />ml I <br />S.O. 7543 <br />Customer Signature <br />IMPORTANTI <br />CALL 1-800-424-5555 48-HOURS <br />j <br />PRIOR TO DIGGING <br />Inspection By <br />CALL 259-8810 FOR INSPECTION <br />Date Inspected <br />z - `?'� <br />SEE SKETCH ATTACHED <br />INSPECTION <br />ral <br />1. <br />