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CHART NO. <br /> evere�t _". � o �os�;,,y � <br /> �r - l�-9i I <br /> � R I <br /> < a' <br /> C!'y of Everett� - � <br /> �e:��er �p�►li�a�tie�►i� and Permit <br /> �; - � � <br /> . Q 1 � <br /> NO. �$�J�� DA"�Ei xarch s, i��__ <br /> � <br /> Service Address �s�� �l�•+*r3- Utility Account No. — <br /> Billing Address �«a,�-3,}g <br /> City, State,Zip _�tw].aar�J.t—SAu��G-- Permit Fee $ 1n nn -- <br /> Owner ��ay�,-- Connection Charge <br /> Connection by ���r Trunk $ <br /> Address �}{,��, Lateral $ <br /> —*,: vaod, ��'A 9R037 Total Connection Charge $ <br /> Phone •_��T— Utiliry Developm�nt Fee <br /> Legal Description: Water $ <br /> Lot . Sewer $ <br /> Block _ Total Development Fee $ <br /> Plat <br /> Unplatted Description: . Sewer Bond District <br /> __ Abutting Lot Line <br /> N�g, E,y�/ — (t. <br /> Typa of Permit _ r���.��-�Q.� �/Z Approved By <br /> r�narks � / �—/��I�� Issued By T R^��.-�.e11 — <br /> � P o�V `�'� � /� _��! Customer Signature <br /> C <br /> IMPORTA T! <br /> CALL 1-800-424-5555 48-HOURS <br /> , <br /> PRiOR TO DIGGING �/ <br /> CALL 259-8810 FOR INSPECTION Inspection ey <br /> Date Inspected 3—��—�� <br /> i <br /> SEE SECETCH ATTACHED r•�o. ?$�.�<i <br /> IfJSPcC i ICf.' <br />