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'everett '" <br />f� <br />.y <br />�.r.. <br />� <br />�J <br />� � a <br />City of Everett ;� � _ <br />,�, w p <br />Sewer A��li�a tion and Permit <br />� ,��� <br />NO. '�9I.O DATE � -�-+s, ,oa+ <br />CHART N0. <br />TO �nS-f I r�l L-� <br />Service Address Utiliry Account No. <br />Bflll�lg AddfBSS 53 ~'� <br />City, State, ZIp ��•. "' Q1'p+ Permit Fee $ � <br />Owner <br />Connection by <br />Address �anm w... oo - <br />�r�vooQ. 11A 950�6 <br />Phone <br />Legal Description: <br />Lot <br />Block <br />Plat <br />Unplatted Description: <br />Type ot 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 />Connectio� Charge <br />Trunk <br />Lateral <br />� <br />/ ; <br />/ /"'% �� <br />( ; <br />! %� �-1 - ;; <br />l� �� � `� <br />;� <br />$ <br />Total Connection Charge $ <br />Utiliry Development Fee <br />Water $ <br />Sewer $ <br />Total Development Fee $ <br />Sewer Bond District <br />Abutting Lot Lfne <br />N, S, E, W <br />Approved By <br />Issued By ��� ., <br />Cusromer Signature `���_ <br />Inspection By � / <br />Date Inspected 9" �� <br />INSPECTION <br />No. 27910 <br />n. <br />