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2.� <br />Y clJ <br />m 1-3 <br />C H <br />�+SyHt�fn <br />tHx� <br />1-3 <br />FC C'1 <br />N <br />z <br />o <br />o <br />Hb <br />H@g <br />ci Y A <br />ZH <br />t"H <br />HH <br />rA <br />Hoy <br />r 1 <br />U <br />I I <br />U <br />r--. <br />Sewer Application and Permit <br />3 3 DATE <br />Service Address 4309 nlyapic Olvd <br />Billing Address 13085 SE 26rh ST #F201 <br />City, State, Zip Bellevue WA 98005 <br />Owner Robert 6 Rhondn Reed <br />Connection by Ilenrthwood Homes IN's �p2ryrC <br />Address PO BNx 2355 d <br />Lynnwood WA 98036 <br />Phone 771-1943 <br />Legal Description: <br />Lot <br />I <br />! Block <br />Plat <br />Unplatted Description: <br />Type of Permit NEW CONNECTION <br />Remarks <br />IMPORTANTI <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 />CHART NO. <br />TO POSTING S -17-U <br />08/26!92 12%41PN 0001iI15580 <br />40003,168 <br />21.00 t549.50 <br />PLBG <br />$55.00 <br />t1ECH <br />$90.00 <br />6 SRCH <br />44.50 <br />PLN CH <br />$2,9' <br />900009M, i <br />lMTER <br />11650.W <br />440002B831 <br />°EWER <br />470.00 <br />Permit Fee $ 70 OQ171 ,5 stiti0 r1n <br />CHFM $2091.93 <br />Connection Charge <br />Trunk <br />$ <br />Lateral <br />$ - <br />Total Connection Charge <br />$ <br />Utility Development Fee <br />Water <br />$ 179.00 <br />$ 471.00 <br />Sewer <br />Total Development Fee <br />$ 650.00 <br />Sewer Bond District <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />Issued By Mt <br />Customer Signature / <br />Inspection By ��hP/�Lll1r1 <br />Date Inspected <br />INSPECTION <br />