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everen <br />� <br />City of fve►ett <br />Sewer Application <br />N0. ZT8O6 DATE <br />Service Address a917 NichoL Plaoe <br />BillingAddress f•n• Box 2217 <br />�� <br />� <br />3 <br />� ��'���� �� <br />� • • � <br />�:� '�? o �- -- � <br />ty r� �... .�-� w .rt r�l � 'i1 <br />K� M �'1 1% �F M � <br />-� Y tA <br />M • � <br />��id�errt��t. ;,, 4' � <br />Cd 'a � u f,� —J V: S� � C- i3 <br />\ � '.JL' L � i CO �cS s Li .�-� .-��Y <br />��5 _ 1 �00 <br />City, State, Zip Poulsbo, WA 9f3370 <br />Owner (�lortgagor►_ D F Ii Conritrur.tion <br />y <br />Billing Name <br />Connection <br />Phone 697-1567 <br />DESCRIPTION: <br />Lot ],5 Block <br />Plat Tr� �.iw (.rnn�Aa <br />Unplatted Description <br />Type Permit: <br />Remarks: <br />IMPORTANT! <br />CALL 1-500-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL259S811FORINSPECTION <br />SEE SKETCH ATTACHED <br />CHART <br />Utility Account N <br />Permit <br />� <br />t <br />•J <br />� <br />� <br />Se�� �-� ��i� <br />30.00 <br />7 �/S-g/ <br />Connection Charge�s) eXempt (ULID Q1) <br />'i otal Fee 30.00 <br />Dtility development fee, Ord. 1171--85: <br />water only 224.00 <br />1 i <br />Signed ----- � ' r�� <br />Cusrofrer <br />Sewer D <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />City Engincer <br />Issue�+ By_ rsarqaret McLc3od <br />Inspection By-�""'`C� <br />Date l nspected > � � y� <br />N0. 2780v <br />INSPECTION <br />