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� CHART N0. � �-�� -5�� <br /> everett <br /> �� <br /> _ ;�� %, "���� <br /> City of Everett <br /> Sewer Application and Permit <br /> NO. 2 $O 6 9 DATE �- � �I ' `a I <br /> ServiceAddress � �� q ��i��'S UtilityAccountNo. <br /> Billing Address <br /> City, State,Zip Permit Fee $ <br /> Owner Connection Charge <br /> Connection by �.i {'.i o� �-�e r�"f'�- Trunk $ <br /> Address Lateral $ <br /> Total Connection Charge $ <br /> Phone Utility Development Fee <br /> Legal Description: Water $ <br /> Lot Sewer $ <br /> Block Total Development Fee $ <br /> Plat <br /> Unplatted Description: Sewer 6ond District <br /> Abutting Lot Line <br /> N, S, E,W tt• <br /> Type of Permit R�,I�Y�1 r Approved By <br /> Remarks � � < < ' Issued By �►J N1!1�r <br /> Customer Signature <br /> IMPORTANT! <br /> CALL 1-800-424-5555 48-HOURS <br /> PRIOR TO DIGGING <br /> CALL 259-8810 FOR INSPECTION Inspection By <br /> Date Inspected <br /> SEE SKETCH ATTACHED rvo. 2 8 0 6 9 <br /> CUSTOMER COPY <br />