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everett <br />e <br />Ctty of Everett <br />C�,;,�,Rl� NO. <br />Sewer Application and Permit <br />NO. ZS4%� DATE , — <br />Service Address , <br />Billing Address • • <br />City, State, Zip , <br />Owner <br />Connection by , <br />Address "R <br />_r��_ <br />/ " � Phone <br />I ��' Legal Description: <br />1 � Loi <br />I� `� Block — <br />� Plat <br />i `�j Unplatled DescripHon: <br />.�l' <br />1� <br />�� <br />Type ot Permit � <br />IRemarF;s <br />IMPORTANT! <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Utility Account No. <br />Permit Fee $ <br />Connection Charge <br />Trunk <br />pntTlNf _. � z L <br />i r� , t;� r: � �F�n �:,�rana� ,; <br />6'�L1(4^.7S''�t <br />G tiEI;H �'�.•`� <br />:i[A?l,."`B� ^.; <br />�;EWIIc i:.`,i0 <br />'Hl[ri�'� 5"[n <br />t;porr_�; s, i`. <br />ru i.• �, �' <br />P�1NSP v:: ;7,0' <br />i;1ii1:J: 1S�i i <br />.Vo <br />Laleral <br />Total Connection Charge <br />Utility Development Fee <br />Water <br />Sewer <br />Total Development Fee <br />$ <br />$ <br />$ <br />,: <br />Sewer Bond District <br />Abutting Lot Line <br />NSEW _ ft. <br />Approved By <br />Issued By * "' � — <br />Cuslomer Signature <br />�� ' //^ <br />c( <br />Inspeclion 8y <br />Date Inspected �� � <br />INSPECTION <br />No. 28473 <br />.� <br />� <br />e <br />