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everett <br />City af Everett <br />Sewer Applica <br />►�o. 28104 <br />;, <br />y a� <br />v cc <br />w� <br />tion^a�r�d Permit <br />i 'i ..� <br />� � <br />• �� J <br />DATEJ Janunty 18, 1991 <br />Service Address � • _ <br />Billing Address s <br />City, State, Zip Evcrect Hn , 4�201 <br />Owner + � ��--_*�_"uL•alxln <br />Connection by <br />Address <br />Phone <br />Legal Description: <br />Lot <br />Block — <br />Plat <br />Unplaned Description: <br />Type of Permit _:rdmvYa=At.� f.7 r:.rwttnn _ <br />Remarks � �---�n, <br />sev�_r <br />IMPnF1TANTt <br />CALL 1-800-42a-5555 48-HOURS <br />PRIOF, TO DIGGING <br />CALL 25y-8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Utiliry Account No. <br />CHART NO. <br />Se �� -1.� P�;"�,.y <br />�,�S,G� <br />Permit Fee $ <br />Connection Charge <br />Trunk $ <br />Laleral $ <br />Totai Connection Charge $ <br />Utility Development Fee <br />Water $ <br />Sewer $ <br />Total Development Fee $ <br />16.00 <br />Sewer Bond District <br />Abutting Lot Line <br />N S E, W ft. <br />Approved By _ <br />Issued By +�:,;r�;,��] --- <br />Customer Signature — -- <br />Inspection By �A`-""�`'� <br />� <br />Date Inspected � " � � - 9 � <br />I�::;, �C"IlOiv <br />NO. ��104 <br />