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H <br />9Hc~i� <br />y <br />"09Nhd <br />JD <br />V1 H <br />oZo <br />H d <br />g <br />t H <br />H �-3 <br />qW� <br />3 R fn <br />�HEEn <br />HOrA <br />i everett <br />�ea _ <br />City of Everett <br />Sewer Application and Per". it <br />zm�wmo'S2 <br />NO.28An7 DATE 9/19/91 <br />Service Address 1^20 Pine St <br />Billing Address ' , &t <br />City, State, Zip FN'rctt wi= <br />owner — - <br />Connection by <br />Address <br />Phone <br />Legal Description: <br />Lot — <br />Block <br />Plat <br />Unplattod 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 />Utility Account No. <br />Permit Fee $ <br />SHART NO <br />TO POSTING Ld Z <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 <br />Customer Signature <br />Inspection By _ <br />Date Inspected <br />1"Je J n <br />z <br />A /e/fsir� �. <br />NO.28427 <br />ft. <br />INSPECTION <br />