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� <br /> CHART NO. <br /> I <br /> ev�rett ' <br /> � I, <br /> � � � Se w�� �v �arS�i.�� � <br /> .. y � 7 -Za 'LZ� <br /> � � � City of Everett I <br /> os� o <br /> � � � � Sewer Application and Permit <br /> O M <br /> M � NO. 279� � DATE e- <br /> h <br /> y I <br /> v~i Service Address Uliliry Account No. <br /> H <br /> O N <br /> � � � Billing Address Q r aq <br /> � y City, State,Zip Permit Fee $ �o Q� <br /> Owner Connection Charge <br /> Connection by — Trunk $ <br /> Address — — Lateral $ <br /> Total Conneclion Charge $ <br /> Phone Utility Develapment Fee <br /> Legal Description: Water S �2d �� <br /> �i�=, Lot Sewer $ 589 00 <br /> `���, Block — Total Deveiopment Fee $ A�� �^ <br /> 1 '�_ � Plat <br /> � �� Unplatted Descriplion: Sewer Bond District �— <br /> � Abutling Lol Line <br /> II__ <br /> __I N� S� E�W �.0 ::�t:7�.� IU-Uti,r1 (i1114i�i—'�`'�'.i fn�l <br /> Type of Permit Approved By = <br /> ii1'tu i.`'`.�i L <br /> ��� Remarks Issued By <br /> !,1,11i +,J.i,v ^�' <br /> �1 � I'IIYi 3fiL00 <br /> Customer Signature— <br /> 1; Sf;t:H j4.'� <br /> < -1.�' ' IMPOHTANI . �ua��ms a^o.�u� <br /> CALL 1-800•424-5555 48-HOURS 6k1TEF• 4:SO.�u� <br /> � � PRIOR TO DIGGING t ������`�� <br /> �='�l ,ft' .;O.T — <br /> Inspection By � � ' <br /> CALL 259-8810 FOR INSPECTION i.�7, "�='� .. - <br /> Date Inspected ��- �� �� <br /> SEE SKETCH ATTACHED No. 27945 <br /> Ih1SP�CTI�N � <br />