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�verett <br />City of Everett <br />�� jj /D� DO g2 <br />� <br />� ��7 <br />�G ?c3 J <br />Sewer Application and ��erm�t <br />No. 2 8 0 81 DATE 3'�• <br />Service Address 2 S^ � �E' C'P'f�Yn <br />Billing Address <br />Ciry, State, Zip - <br />Owner <br />Connection by � I T� D t- Ff)C,° hE� <br />Adoress <br />Phone <br />Legai Description: <br />Lot — <br />Block <br />Plat <br />Unplatted Description: _ <br />UUlity Account No. <br />Permit Fee $ _ _ <br />Connection Charg:� <br />Trunk <br />Lateral <br />Tolal Connection Charge <br />Utility Development Fee <br />Water <br />Sewer <br />Tolal Development Fee <br />$ <br />$ <br />$ <br />Sewer Bond District <br />Abutting Lot Line <br />N, S, E, W ft. <br />Type oi Permit 1<�LI � V' �' � dr i¢ �2 Approved By <br />Remarks�R^,�.� ?-o� 07-.�-.— -�rr/��'-' d Issuer+ 6� —s�t' IV a� ���t� �" <br />�� �p � � tc.a '� ��� ✓�• Customt iignature - <br />T P o f i,2.c-,,�/ � ' b . .5 � D � /� �0 . <br />IMPORTANT! �3 i� a/ MN @ BA1��, <br />T <br />CALL 1-800-424-5555 48-HOURS <br />P�iIOR TO DIGGING <br />�nspection sy 3 - /� � 9/ <br />CAl_L 259-8810 FOR IPlSPECTION i <br />Date Inspected _ . "��—�4 - <br />SEE SKETCH ATTACHED NO ��' l�� � 1 <br />, <br />i:l_iSTi�'r.ii-R r .., i <br />