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everett <br />e <br />Ciry of Everett <br />d <br />� <br />� ss�R$ � <br />r �rA.�M;,� S <br />Sewer Application anc�P�rmi#__ � _ <br />p+ L <br />� �1-�.��I Uu• �}[� <br />` 3 y� 1; i..7 tJ �� <br />N0.279?_9 DATE ��-����5..���990 <br />Service Address <br />Billing Address <br />City, State, Zip <br />OM1118f . . <br />Connectlon by — <br />Address <br />Phone <br />Legal Description: <br />Lot <br />Block <br />Plet ' <br />Unplatted Description: <br />Type of Permit <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 />Utiliry Accounl No. <br />NO. <br />T� P(1CTINf, a �� z <br />PermitFee $ <br />Connection Charge <br />Trunk $ <br />Lateral � <br />Totel Conneclfon Charge S <br />Utiiiry Development Fee (� dil� �l►ou�,n8uel.idrd— <br />a�a 11 —119) <br />Water $ <br />Sewer $ <br />Total Development Fee S � <br />Sewer Bond Districl --- � <br />Abutting Lot Lfne <br />N, S, E, W n' <br />Approved By <br />Issued By <br />Customer Signature <br />Inspection By ���� <br />Date Inspected <br />W 3PECTI ON <br />No. 27929 <br />