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�� C � <br /> ta � <br /> A � x <br /> Q H <br /> y r3 !n <br /> H � �' <br /> H �-+ <br /> fCy � <br /> � � � CHAflT fdC?. ------ <br /> VJ H <br /> � �� � �verett T� POSTIi`iG �/ � � z I <br /> � I <br /> " � g I <br /> �� � <br /> � � <br /> zH _ <br /> � y z City of Everett ru�:��-i: ?=:'�r',r, ���;I�:iei ; <br /> H �3 � <br /> g �� Sewer Application and Permit �_�'�' 3-�.� '�� . <br /> erroiiz s�zs.c� <br /> ii7iis �a�i.�n <br /> y o vi I 7�EC1: 41�"6.tto <br /> NO. Zg7.3O DATE .tav z7 lasz _ L ' <br /> Service Address —2�.7.�1io11X-T' Utiliry Account No. — <br /> � Billing Address �'^ '�'" 4='�oa Way <br /> I <br /> � City, State,Zip ��Ltr—�-��94 Permit Fee $ ��-�" <br /> Ow-er Cennection Charge <br /> iConnection by �— Trunk $ s'+o on <br /> � Address Lateral $ ��� rn <br /> �' Total Connection Charge $ TZ''�o , <br /> r 9�.,�t � <br /> ....,e. I� <br /> � Phone _ Uliliry Development Feo I <br /> ; Logal Descript�on: Water $ ! <br /> ��� <br /> •.' � ot _ Sewer $ 47i_o�� . <br /> w. <br /> Block _ Total Development Fee $ �71.^^ <br /> io„�� Plat ._ � <br /> Unplatted Description: Sewer Bond District B°nd IZI <br /> �'A� _ _ AbuQing Lot Line <br /> Pc. <br /> _ _ N�S, E�W I <br /> ���u Type of Permit Approved By R Rrookv <br /> u <br /> ��� . <br /> Re.marks Issued By a--� � " <br /> � Customer Signature— � <br /> i I <br /> ( "�� IMPORTANT! <br /> \ <br /> CALL 1-800-424-5555 48-HOUHS <br /> PRIOR TO DIGGING L� � , , � � <br /> In:;pection By�" � <br /> CALL 259•8810 FOR INSPECTION �( 92 I <br /> Da e Inspected I <br /> I SEESKETCHATT�aCHED NO. 2�7�J II <br /> � <br /> � � <br /> IW SP�CTION ' <br /> � <br /> - __— ___--___ - ._ ... . . . ...,.2�':b?..rl;l. . - � rs4,l�::t:' . .. =i:'�. . <br />