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CHART NO. <br /> ev�rett <br /> se�l �v �f� �� <br /> _ ; _ �[ _9� <br /> � <br /> ' s� s? :�; .� o � � ? =� <br /> City of Everett = �; �_ - � _ - ;, �, <br /> _ :, . � � _ <br /> _ . .. ,.; � - <br /> Sewer Applicatio�.and �eirml�Y �� <br /> a � ;� <br /> .e' �'+ '`+ f �+ � <br /> .. r� ..� � �` /' :{ �- � _ .�� w � <br /> No. 27994 QA� ' <br /> Sarvice Address 79�6 r. y�._� Utility Account No. <br /> BilNng Addross <br /> Ciry, State,Zip Permit Fe� $ � <br /> . <br /> Ovmer _ Connection Charge <br /> Connectiun by Trunk S— <br /> Address Lateral S �- <br /> — Total Connection Charge $ <br /> php�e Utility Development Fee <br /> Lepal Doscription: Water S � <br /> �t _ Sewer S �I1.�-- <br /> B� — Total Development Fee a �SO.00 <br /> Plat <br /> Unpletled Deacriptlon: • Sewer Bond District <br /> Abutting Lot Line <br /> NSEW ft. <br /> Type of Permit ,��,p Approved By <br /> Remarks _ _ — Issued By <br /> _ Customer Signature <br /> IMPORTANT! <br /> CALL 1-800-424-5555 48-HOURS � <br /> PRIOR TO DIGGING `, - , <br /> Inspection By <br /> aC,t-" <br /> CALL 259-8810 FOR INSPECTION -� � 1 <br /> Date Inspected �� � �� l �' I <br /> SEE SKETCH ATTACHED No. Z�T994 <br /> u��r�rciioN <br />