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:�.,: <br />everett <br />Clty of Everott <br />m <br />a <br />� <br />� �8 <br />00 <br />., .., ., <br />c� "'► <br />Sewer Application ar� ermit <br />�� 28048 DATE B�ceb�r�7. �9� <br />�^� �re� - �� ���"� Utility Account No. <br />BRNpp Addresa •-- <br />GIY� State� ZiP . <br />Owr�er Ds. �tc6 <br />Connecxfon by �•� <br />1 nddreas <br />Phone 2sa_oann <br />Lepel DeacripNon: <br />�1 <br />saa� <br />Plet <br />Unplatted Desaipdon: <br />Type of Permit <br />Remerks _ <br />IMPORTANT! <br />'Ta �jP 5 ��'iJ <br />� <br />l 6l�bl�/ <br />Pertnit Fee a 10.00 <br />Connection Charge <br />Trunk <br />Lateral <br />Total Connectbn Charge <br />Utility Development Fee <br />Water <br />s��� <br />Total Development Fee <br />Sewer Bond Dis:rict <br />S <br />a <br />$ <br />a <br />a <br />$ <br />Abutting Lot Line <br />�� N, S, E, W ft. <br />� Approved By <br />e'w � � y <br />ISSU6d B Hsz�aL�t !leLed <br />CALL 1-800-42M5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8610 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Customer Signature <br />Inspection By _ <br />Date Inspected <br />INSPECTION <br />No. 28048 <br />