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everett <br />e <br />City of Everett <br />Sewer Application and Permit <br />NO. 2$% S O DATE _ <br />Service Address <br />Billing Address <br />Ciry, State, Zip aa vA 98201 <br />Owner c c i,.. . — <br />Conner,tion by <br />P.ddress <br />Phone — <br />Legal Description: <br />Lot <br />Pi, � <br />Unplatted Description: <br />Type of Permit u nA+ -- <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 />CHART NO. <br />Tn pncTlNf �/i9/� <br />lk�'lWlS.' 1I:`JL'�'rdi il(N.tllil•�:�:.i t6...t <br />Permit Fee $ ' <br />A t7�8�5D <br />ConnectionCharge SEuER etU.Lx? <br />t_ fiE�ll 4t0.1K1 <br />Trunk $ <br />Laleral $ <br />Tolal Connection Charge $ <br />Utility Development Fee <br />Water $ <br />Sewer $ <br />Total Dev :lopment Fee $ <br />Sewer Bond District <br />Abutting Lot Line <br />NSEW ft. <br />Approved By <br />Issued By <br />Customer Signature- <br />Inspection By � � '� <br />Date Inspected � �' - � � <br />INSPECTION <br />NU. ZS�T5O <br />