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J <br />everett <br />� <br />� <br />� <br />� a �4r�,�� <br />City of Everett � � <br />,Y'•-,, ei� � �� w i <br />t)'1 Y +« <br />Sewer Application and �?,�[.�x�it _, <br />� f����Rv}� V u' <br />� J a .� _'�-. c'] �i'� � — <br />NO. 2$O�is DATE ,.,.� 6a* s� iy4o <br />Service Address _3�„+ Gsaod Aw Utility Account No. <br />Billing Address <br />City, State, Zip "�•*•tt, v` on�nt <br />Owner <br />Connection by <br />Addf9SS zS�6 I+rddrTsi� xvarwtr 9A901 <br />Phone <br />Legal Description: <br />Lot <br />Bbck <br />Plat <br />Unplatted Decc�fption: <br />CHART NO. <br />SeNf b paa�aq <br />7 z� -5 I <br />Permit Fee $ ��•� <br />Connectfon Charge <br />Trunk <br />Lateral <br />$ <br />$ <br />Total Connectfon Charge $ t••+� <br />Utiliry Development Fee <br />Water <br />Sewer <br />Total Development Fee <br />Sewer Bond District — <br />Abutting Lot Line <br />N, S, E, W <br />TypeofPermit �� ��+ �f��ia—*ro a.��+tidk�rovedBy <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 />$ <br />$ <br />$ ezistinr. <br />Issued By Harrarat McLeod <br />Customer Sfgnature <br />Inspection By <br />Date Inspecte� <br />INSPECTIUN <br />i� <br />No.28046 <br />I <br />