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� � CHART NO. <br /> � m <br /> � everett .�i U� <br /> M I g <br /> � N e ��i {� � <br /> � " �-y'� � '�, \ <br /> � , <br /> � � � <br /> y " City of Everett <br /> °�° � � <br /> � � '� Sewer Application �.:�d Permit <br /> � � _ <br /> H <br /> �py y I NO. 2HO96 DATE � " � � 9 � I <br /> O O N ( <br /> � � r ,Q� + �Q � •�I t�' � �/� Utiliry Account No. <br /> � � Service Address I <br /> N <br /> I Billing Address I <br /> ' Cfty,State,Zip Permit Fee $ <br /> Connection Charge i <br /> Owner I <br /> �� i }� � p F � l lE YF�� Trunk $ <br /> i i �nnection by I <br /> Laleral $ <br /> I Address <br /> i Total ConnecNon Charge S � <br /> I i <br /> I Phane Utility Development Fee ; <br /> � C�� I:' LegalOescription: Water $ <br /> ; Lo� Sewer $ <br /> , Total Development Fee $ <br /> �� Block <br /> ' ' I� <br /> Plat <br /> i Sewer Bond Distric[ I <br /> '� Unpletted Description: � <br /> i ��� I � O ��, � i y�,�, ` � �; �,D��c a Abutting Lot Line n I <br /> i ! � ,� c i N,S�E�W I <br /> '� / p" o /' ,�_ Approved By ' <br /> ��� Type of Permit ��c' �1. <br /> ! �� � ���/�� � t1 f�A � I 1 r Y <br /> i <br /> Remarks t/aa ��'� �� �'O n�'�'-�-�'-�`j-•-- Issued By <br /> a ( ' ' 'I { Custumer Signature <br /> � , IMPORTANT! <br /> �'� I <br /> ��l I CALL 1-800-424-5555 48-HOURS <br /> PRIOR TO DIGGING <br /> Inspeclion By <br /> CALL 259-8810 FOR INSPECTION Date Inspected <br /> SEE SKETCH ATTACHED <br /> No. 28096 I <br /> • uriuTv�i�ur�c '� <br /> I <br />