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everett <br />�,e� <br />Clty of Everett <br />Sewer Application and Permit <br />NO. 28136 DATE 02-20-91 <br />Service Address 6304 eakm Ave. <br />Billing Address <br />City, State, Zip <br />, Owner <br />Connection by <br />Address Mom XVS. S. <br />Phone <br />Legal Description: <br />Lot <br />Block <br />Plat _ <br />Unplatted Description: <br />Type of Permit <br />k. <br />Remarks <br />e SC ° �(C� <br />IMPOR ANTI <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />CHART NO. - <br />to Post�h9 <br />Utility Account No. <br />Parmit Fee $ 1000 <br />Connection Charge <br />Trunk <br />$ <br />Lateran <br />$ <br />02/,)1/91 4246M i.Y.k rjTM fl't:t <br />Total Connection Charge $i <br />Utility Development Fee <br />St WET, t10.00 <br />Water <br />Pt0.10 <br />Sewer <br />$ <br />Total Development Fee $ — <br />Sewer Bond District <br />Abutting Lot Line <br />N, S, E, W <br />tt. <br />Approved By <br />Issued By <br />-- - <br />P.HeAft <br />Customer Signature <br />Inspection By <br />Date Inspected <br />INSPECTION <br />NO.28136 <br />