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� y <br />C�H <br />9Hy <br />H�� <br />FC f� <br />��� <br />� yp � <br />H <br />o� <br />��g <br />t"y� <br />yy <br />g�� <br />� y � <br />0 <br />P <br />� <br />everett � <br />e � _____�. <br />�; ,.� � R s-r ;, <br />c � `_ � � '�' - <br />City of Everett �-='�. ;� _ g o y�, <br />�' .. ;' .. . = .n o <br />» r� <br />Sew�r Appliceti�n a�n_d �C��rm�f <br />O p `� � E1 '.1i :..1 <br />�.S G c'�I i.�_' l� "nui �' 2 �a. �• Y- + <br />7� JJ �� j� LL� I1i J� T� C��"n f�� <br />N0. 2 cg % ` DATE �e �, 1992 <br />SBNICB %lddf@SS cn�n .�....... a <br />Billing Adoress Si i n^""" -`t <br />Ciry, State:, Zip �--�-•« u' qQ�na <br />Owner �— <br />Connactbn by — <br />Address <br />Phone ��� ta�� <br />Legal Description: <br />Lot <br />Block <br />Plat <br />Un�latted Description: <br />Type of Permit <br />Remarks _ <br />IMPORTANT! <br />CALL 1-800-424-5555 48-HOURS <br />PRIQR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Utility Account No. <br />CHART NO. <br />PQSTItaG._5_z7-93 <br />Permit Fee $ 30.00 <br />Connection Charge <br />Trunk <br />Lateral <br />Total Connection Charge <br />Utility Development Fee <br />Water <br />Sewer <br />Total Development Fee <br />$ 270.09 <br />$ 4so 00 <br />$ 720 00 <br />$ 224.00 <br />$ Sea.oO <br />$ ata nn <br />Sewer Bond District Aotm ii <br />Abutting Lot Line <br />N, S, E, W h� <br />Approved By <br />Issued By J �kwe+11 <br />Customer Signature ' ` ' � <br />, <br />Inspection By ��� �`� — — <br />Date Inspected — ���j <br />INSPECTION <br />No. 28767 <br />