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�n� <br />��x <br />aHc~n <br />rm <br />y � F-�+ <br />� y� <br />O HO <br />y y L'~g" <br />� o t� <br />HG <br />��g <br />yn Y � <br />H <br />E'"yZ <br />HH <br />g`� <br />H <br />cq] t7 y <br />[�f � C��1 <br />z y �n <br />H O (n <br />everett <br />e <br />City of Everett <br />Sewer Appl�cation and Permi� <br />NO. 2��? 9 DATE 1;ovemher 2S t cql <br />Service Address �^� �� au st Utility Account No. <br />Billing Address ---ry�—pa�� „ _ <br />Ciry, S�ate, Zip —bvoratt.,._�:1�9E:�0� <br />Owner —,_�v��a�;,���e�ite� <br />Connectian by — <br />Address �nr.� u i •.s <br />—��#n�tex,--vr�--saZ� <br />Phone _o�y�q� — <br />Legal Description: <br />Lot �}e c �c <br />Block <br />Plat � rr Mv tt <br />Unpiatted Description: <br />Type of Permit can �� <br />Remarks <br />IMPORTANT! <br />CALL y-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />�''ART NO. <br />i0 P��TiNr, ��Z�/qZ <br />1.'.iil��7? 'i��i'I`II (b'.ltil;i li.� <br />;l000.''8197 <br />C SF:CH f�i.�� <br />'b]00�5,^9 <br />=14q:i' "::.'.�i <br />0. �-i: I l 4 ; .ik? <br />Permit Fee $ 2.50 <br />Connection Charge <br />Trunk <br />Laleral <br />Total Connection Charge <br />Utility Develapment Fee <br />Water <br />Sewer <br />Tolal Development Fee <br />� <br />$ <br />$ <br />$ <br />$ <br />$ <br />;:;:. <br />Sewer Bond District <br />Abutting Lot Line <br />N, g� E� yd it. <br />Approved Dy <br />Issued By s itockwell _ <br />Customer Signature <br />G]% ��- i, ��� <br />v �—� op�� <br />Inspection By � <br />Date Inspected � <br />INSPI_C110�! <br />No. 28529 <br />