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��� <br />a � <br />��� <br />� <br />��� <br />��� <br />O <br />�� <br />QMr <br />Zs N <br />C" y <br />H <br />�A <br />M <br />�� <br />O� <br />� <br />1 C� <br />everett <br />e <br />City of Everett <br />SewPr Applicat <br />No. 27884 <br />Service Address ��� ��� A� <br />Billing Address � � �'��� �l � <br />City, State, Zip ��-^�'�'- � oa�ns <br />.. •• <br />Connection by <br />Address <br />Phone 317-i181 <br />Legal Description: <br />Lot _ <br />Blxk <br />Plat <br />Unplatted Descdpt(on: <br />Type of Permi�� .ti+.. a-�-t <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 Account No. <br />CHART NO. <br />T(1 PQSTING ��z <br />Permit Fee $ 30.00 <br />Connection Charge <br />Trunk <br />Laterai <br />$ <br />$ <br />Total Connection Charge $ rr+� <br />Utility Development Fee <br />Wafer <br />seWa� <br />io;al Development Fee <br />$ <br />, ,. <br />a 650.00 <br />Sewer Bond District �y+��^"'� <br />Abutting Lot Lfne <br />N, S, E, W <br />Approved By <br />Issued By <br />Customer Signature <br />Inspeclion By ��' "�`��� <br />Date Inspected <br />INSPECTION <br />� <br />IvO. 27004 <br />it. <br />