Laserfiche WebLink
�� <br />� <br />��y <br />��H <br />ayv� <br />H �H <br />ft C� <br />H 77 <br />� (A H <br />�Zp <br />HC <br />ON <br />��8 <br />�] V �% <br />t� y � <br />Ny <br />� Cy <br />��� <br />HON <br />� 1 <br />— <br />everett <br />e <br />City of Everett <br />S�o`�5���� <br />5/ 5.,��.�o o��� <br />(07 <br />CHART N0. <br />� _ : ; �:-� <br />% -j/ <br />Sewer Application and Permit <br />NO. ZHO9O DATE S� ��J' �� J <br />Service Address �3 .� � r'Z R � A% I�� <br />Billing Address <br />Ciry, State, Zip <br />Ovaner <br />Connection by 1'�� 1 !'i � CuL° rE "� r <br />Address � <br />Phone _ <br />Legal Description: <br />Lot <br />Block <br />Plat <br />Unplaried Descri�tion: <br />'(,�' Type oi Permit QP,.�nA � h -- <br />Remarks �� � � �--�o _ . � o <br />�'� i IMPORTANT! <br />i— <br />�� <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 />Permit Fee � <br />Connection Charge <br />Trunk <br />Lateral <br />Total Connection Charge <br />Uti�ity Development Fee <br />Water <br />Sewer <br />Total Development Fee <br />$ <br />$ <br />$ <br />$ <br />$ <br />S <br />Sewer Bond District <br />Abutting Lot Llne <br />N, s, e, w n. <br />Approved By <br />iss�ad sy _�ar� /l/� i I Ie Y <br />Customer Signature <br />�A�� G'� <br />SS @ P�L. ��� <br />ir6 , N �� ti,� p ��y��. <br />Inspection By <br />Date Inspected G ��� <br />UTILITY BILLING <br />No. 28090 <br />. <br />%' <br />