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everett <br />0 <br />City of Everett <br />Sewer Application and permit <br />NO. 28068 DATE S->7/ <br />Service Address Are' 4� eaz Utility Account No. <br />Billing Address <br />City, State, Zip <br />Owner / <br />Connection by cuuz 42, <br />Address <br />Phone <br />Legal Description: <br />Lot <br />Block <br />Plat <br />Unplatted Description: <br />Type of Permit a pA�i? - 'c or c S/ <br />Remarks/1s <br />i <br />IMPORTANTI <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-88810 FOR INSPECTION <br />� s 12 @ / �� <br />EE SKETCH ATTAC ED <br />Permit Fee $ <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 G <br />Date Inspected <br />UTILITY BILLING <br />ft. <br />