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everett <br />City of Evereri <br />Sev��r A�plicat <br />No.286f;� <br />w <br />CHART N0. <br />� T(1 D�C�I��i�r _:.�!3 <br />� <br />_ 4,. .r =� �. ;: �r� G }J <br />� <br />„ _ _ �: - � - `� <br />— _ _, « �_ .;, <br />i�r�:a�id P.err�iit=� :. <br />_ _ ���;�.::u � <br />_� _ � `a;�_�J..'3'w�' �-j <br />�� :r. y -` G :� � _ G � ;` ;f: ... <br />DATE" r,iii�,�- - - <br />ServiceAddress >>s u r,,...cic.� Auo <br />Billing Address <br />City, State, Zip —_�rsn � o <br />Owner <br />ilEart �woo omes — <br />Connection by <br />Address <br />Phone <br />Legal Description: <br />Lot <br />Block <br />Plat _ sr35-gy <br />Unplatted Description: <br />Type of Permit <br />.sew cor,nec on <br />Remarks <br />IMPORTANT! <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8870 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Utility Account No. <br />Permit Fee $ <br />Connection Charge <br />Trunk <br />Lateral <br />Total Connection Charge <br />Utility Development Fee <br />Water <br />Sewer <br />Total Development Fee <br />Sewer Bond District <br />Abutting Loi Line <br />N, S, E, W _ <br />Approved By _ <br />Issued By <br />Customer Signature <br />$ a�e.ee <br />g �as.�o <br />$ 725 n[7 <br />$ <br />..,, ,,,, <br />—t*�-..,e----- <br />$ „ _.— <br />-- �i <br />�_ _ <br />� <br />� <br />Inspection By <br />Date Inspected �' <br />INSPECTION <br />No. 2$661 <br />� <br />ft. <br />