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everett <br />� <br />r., <br />:� <br />� � �� <br />City of Everett } o d o <br />... sT h4 <br />ti <br />Sewer Applicatio�_,� � Permit <br />� � 3�3 �iy,il <br />�.� ti %�' <br />No.28575 DATE I/3o/9z <br />ServiceAddress 6012 F tq,�no]ia <br />Billing Address 15 6 N lOzr � P7 cr <br />City, State, Zip F..a*.�r u� aa�nA <br />Utility Account No. <br />Permit Fae $ <br />Owner n�n Rarhart Connection Charge <br />Connectionby �oxt r� •�..�•Son Co <br />Address 7dG3 HcPherson Rd <br />_ A 7ingtnn Lih �i4�'1'i <br />Phone r sz_„ �a <br />Legal Description: <br />Lot <br />Block <br />Plat <br />Unplatted Description: <br />Type of Permit Repair <br />Remarks <br />IMPORTANT! <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Trunk <br />Lateral <br />CHART N0. <br />Tn PosT�Nc. _ �- 3 <br />Total Connection Charge <br />Utility Development Fee <br />Water <br />Se�yer <br />Total Development Fee <br />Sewer Bond District <br />Abutting Lot Line <br />N, S, E, W — <br />Approved By _ <br />Issued By <br />Customer Signature <br />$ <br />$ <br />$ <br />__-�I�`�""l`"_� _— <br />Inspection By <br />Date Inspected �� 3�- � � <br />INSPECTION <br />No. zs575 <br />� <br />