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No� <br />��H <br />� H <br />YHCn <br />��� <br />'+tl H '� <br />Hy <br />� <br />o�d <br />♦/ <br />��g <br />t�y� <br />��H <br />n�y <br />�HN <br />HOp� <br />everett _ <br />� •,J <br />City of Everett�: _ _ -' " _ � �. _ _ <br />C•' , . - " : - <br />Sewer ap�licatiQn`�a�d �Permit <br />J - �� L � � � � � =' , =. ` �. <br />. /'� Y � � � � � � .� <br />NO. �g 4�� ���DATE� se�c. o, 19�1 <br />Service Address 2415 W Hukilteo 51vd <br />Billing Address g502 19r.t! nve SL <br />Ciry, State, Zip �vecece NA 5a203 <br />Owner H U Tackitc <br />Connection by ,Q+--. ' -r <br />Address <br />Phone <br />Legal Description: <br />Lot 12 <br />Block — 2 <br />Plat ➢urlin�ton <br />Unplatted Description: <br />Type of Permit t:ev cannection <br />Remarks <br />IMPORTANT! <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 253-8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />CHART NO. <br />TO POSTING �/Lz/9z <br />Ulility Accaunl No. g�H� <br />PermitFee $ 'to.nn <br />Connection Charge <br />Trunk <br />Lateral <br />Tolal Connection Charge <br />Utility Development Fee <br />'Na;e� <br />Sewar <br />Total Development Fee <br />Sewer Bond District <br />Abutling Lot l.ine <br />N, S, E, W __ <br />Approved By _ <br />Issued By <br />Customer Signature <br />$ 270.OG <br />$ 450.00 <br />$ FSB�SIQ 726.00 <br />$ 21.4.00 <br />g SII9.00 <br />$ X2ET31� 813.00 <br />Inspection By ��r�^^-^" <br />Date Inspected �'-'"-`' ' <br />INSPE"TION <br />No. Z8n13 <br />� <br />