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everett <br />City of Everett <br />Sewer Application and Permit <br />NO. 28620 DATE ?7 1992 <br />Service Address —34:5 1t — <br />BillingAddress—�9z9.1o1by — <br />City, State, Zip-,-�ttT�� 99?93 <br />Owner John ea7_,-vin _ — <br />Connection by Wtt t Go <br />Address .fig-?3,�SePharzom , . <br />a•ll.ngtaar�i.1 9'4a�3 — <br />Phone — <br />Legal Description: <br />Lot <br />Block — — <br />Plat --- <br />Unplatted Description: — <br />Type of Permit <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 />Utility Account No. <br />;,HART NO. — <br />TO POSTING 3 �- <br />02/Z 92 2.19Pti WMIll246`r tW <br />NOD028620 <br />sm $10.00 <br />CWD( $10.00 <br />Permit Fee $ ,-10 00 <br />Connection Charge <br />Trunk $ <br />Lateral $ <br />Total Connection Charge $ <br />Utility Development Fee <br />Waler $ <br />Sewer $ <br />Total Development Fee $ <br />Sewer Bond District <br />Abutting Lot Line <br />N, S, E, W — <br />Approved By .— <br />Issued By IT R <br />Customer Signature <br />Inspection By _ <br />Date Inspected <br />INSPECTION <br />e-9z_ <br />NO. 25620 <br />ft. <br />