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everett -J <br />� <br />� <br />s <br />� <br />� <br />City of Everett � � � <br />r� r . <br />,. ... <br />Sewer �� � Iication <br />, ��`'� ,� <br />�:q � <br />NO. LH�I�a� DATE <br />Service Address <br />Billing AddreSS " ' <br />City, State, Zip —b �--� "'—°f'�l <br />Owner ao11Na Mb� �on <br />Connecllon by " '�n'�'*r <br />Address <br />Phone +t�_,.�• <br />Legal Description: <br />Lot <br />Block <br />Plat <br />Unplatted Description: <br />CHART NO. <br />5 e n�- ib ��os�(� �'°I <br />� 26-�i� <br />and Permit <br />�,�sz�m}�. <br />. �_ <br />Type o( Permit �•�""'•4"' <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 />Permit Fee $ l0 00 <br />Connection Charge <br />Trunk $ <br />Lateral $ <br />Total Connection Charge $ <br />Utility Development Fee <br />Water $ <br />Sewer $ <br />Total Development Fee $ <br />Sewer Bond District <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />Issued By —.�--rsekaa� ,: <br />Customer Signature � / � <br />Inspection By �" `'�`�—� <br />Date Inspected <br />INSPECTION <br />7-i�-5'i <br />No. 28318 <br />u� <br />