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everett <br />,e <br />City of Everett <br />t <br />Sewer Ap -ation and Permit <br />NO. 2 9 2 q % _ DATE July is, 1991 <br />Service Address 2702 tioyt <br />Billing Address — 27o2 voyt <br />City, State, Zip 74,verett, WA 98261. <br />Owner City of Everett <br />Connection by owner <br />Address <br />Phone <br />Legal Description: <br />Lot <br />Block <br />Plat <br />Unplatted Description: <br />Type of Permit <br />Remarks <br />ALTZRATION <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 />POSTING � <br />Utility Account No. <br />Permit Fee $ in -an <br />Connection Charge <br />Trunk <br />$ <br />Lateral <br />$ <br />Total Connection Charge <br />$ <br />Utility Development Fee <br />Water <br />$ <br />Sewer <br />$ <br />Total Development Fee <br />$ _ <br />Sewer Bond District <br />Abutting Lot Line <br />N, S, E, W ft. <br />Approved By <br />Issued By 'r 3to jl lI <br />Customer Signature _ <br />Inspection By _ <br />Date Inspected <br />No. 28297 <br />INSPECTION <br />