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everett `� <br />� <br />� <br />�, <br />�, <br />� <br />City of Everett � � � � <br />� + N i� <br />W P '+� <br />Sewer � I�'�ation <br />� � �� <br />° � � �, <br />NO. � � . � DATE <br />Service Address . <br />Billing Address <br />and Permit <br />Utility Account No. <br />City, State, Zip •� � 9Y�0� Permit Fee $ <br />Owner <br />Connection by <br />Address <br />Phone <br />Legal Description: <br />Lot <br />B!ock <br />Plat <br />Unplatted Desc�iptlon: <br />Type of Permit <br />Remarks <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 />Connection Charge <br />Trunk <br />Lateral <br />� <br />$ <br />Total Connection Charge $ <br />Utility Development Fee <br />Water $ <br />Sewer $ <br />7otal Development Fee $ <br />Sewer Bond Dfstrict <br />Aburiing Lot Lfne <br />N, S, E, W <br />Approved By <br />ft. <br />Issued By ' <br />� � r � <br />CustomerSfgnature-��'� ` c <br />;,c� . _ . i� _ <br />f` <br />Inspection By <br />Date Inspected S G -g" <br />INSPECTION <br />No. 27903 <br />