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' CHART N0. <br /> everett <br /> ' � ° ��' n <br /> � �i��J� D� ° <br /> �� �L� �� <br /> ��5�0�]�M <br /> ��� City oi Everett <br /> � , - s" ` <br /> a�y Sewer Application and Permit � <br /> H �H <br /> fC C� <br /> H xl <br /> � H� NO. 2 8 O �1 DATE �5 - •'? t'1 -�i I <br /> V1 N <br /> � p� Service Address ��'� � � ' ���Ai�� a Uliliry Accaunl No. <br /> yC <br /> � � Billing Address <br /> H C�7� <br /> z N� City,State,Zip Permit Fee S <br /> � H� Owner L ConnectionCharge <br /> g �'H Connection by ���- " P �-C Trunk S <br /> � �ay cn <br /> � �!� Address Lateral $ <br /> y p y Total Connection Charge $ <br /> Phone Utility Development Fee <br /> Legal Description: Water $ <br /> � Lot Sewer $ <br /> I��� Block Total Development Fee $ <br /> Plat <br /> � 1 Unplatted Descriplion: — Sewer Bond District <br /> Abutting Lot Line <br /> �� N,S,E,W h• <br /> w _ Type 01 Pefmif '�F' ��a��Q� ����— APP�OVBd By <br /> � � Remarks �i[���$4 '` ' � I�i�^rn n2^i.✓ Issued By L7�>N 1�'"� I ��P �' <br /> 1 ��� <br /> � �p � �� Customer Signature <br /> .� J � � <br /> ��� IMPORTANTI ���� �� <br /> � �� CALL1-S00-424-5555 48-HOURS S,SPoe p�L. � I � � a 15% <br /> PRIOR TO DIGGING f �5 i AJ. o � <br /> Inspection By <br /> • % CALL 259-8810 FOR INSPECTION S�q J <br /> Date Inspected � <br /> SEE SKETCH ATTACHED r,o. 2 8 0 91 <br /> CUSTOMER COPY <br />