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0 <br />+ �� <br />��1 <br />everett <br />� <br />e �, <br />� �,����� �s s� <br />City ot Everett � � ,; ;� � * � v � � � <br />p 3 <br />�2 r <br />Sewer ApplicatiQn �nd -Pe�.it „ _ <br />..; � �� u � � <br />� �R��s����' �� <br />NO. Z%9ZH DATE �.==" - `°+�o <br />Service Addres� <br />Bllling Address <br />Clty, Sta;e, Zip , <br />Owner • • <br />Conneclion by <br />Address — <br />Phone _ <br />Legai Descriptfon: <br />�oc .— .-- <br />� Blodc <br />§ f�lat ' <br />Unpla�ted DescriPtion: <br />e <br />Type ot Permit <br />Remarks <br />IMPORTANTI <br />CALL 1-800-42M5555 48-HOURS <br />PRIOR TO DIGGING <br />CpLL 259-8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />CHART NO. <br />Utility Account No. <br />Permit Fee $ <br />Connection Charge <br />Trunk <br />TO POSTING_ � �� '_ <br />$ <br />Lateral $ <br />Total Conneclion Charge $ <br />Utility Development Fee <br />Water <br />Sewer <br />Total Development Fee <br />Sewer Bond District <br />Abutting Lol Line <br />N, S, E, W <br />Approved By <br />Issued By <br />Customer Signawre <br />�.� <br />$ 6S0 0� <br />ni%c��l� _ <br />Inspection By / <br />Date Inspected <br />INSPECTION <br />n�o.27928 <br />ft. <br />