Laserfiche WebLink
everett <br />City of Everett <br />Sew�r Applicat <br />No.28�t42 <br />�T <br />� <br />� � <br />� <br />:� <br />s <br />ion and Perr�i� � �, � <br />•`j � �j ''� <br />,�i = c 'z <br />DATE ���rz s,�ivso <br />ServiCe AdflfeSS �gll Gran�'. Ave <br />Billing Address <br />Ciry, State, Zfp � <br />Owner .toe� � �r�ec <br />Connection by � � «rt+^^ <br />Address <br />Phone YSti-4331 <br />Legel Description: <br />Lot <br />Block <br />Plat <br />Unplatted Description: <br />Type of Permit cao off <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 />CHART NO. <br />Utility Account No. — <br />Permit Fee $ <br />Connection Charge <br />Trunk <br />Lateral <br />Total Connection Charge <br />Utility Development Fee <br />Water <br />Sewer <br />Total Development Fee <br />$ <br />$ <br />$ <br />$ <br />$ <br />$ <br />2.50 <br />Sewer Bond District <br />Abutting Lot Line <br />N, S, E, W h• <br />Approved By <br />Issued By �'�rgaret NcLaod <br />Customer Signature <br />�/O��e�O N <br />�� <br />Inspection By �L/I � <br />Date Inspected <br />wsPecrion <br />No. zsoas <br />n <br />