Laserfiche WebLink
,. - ...�.,, <br /> f�:. , <br /> r : --�-�---r_--- ----- ---- --- ---- - - - <br /> ' <br /> CHART N0. <br /> I I <br /> =, -' ��, TO POSTING � �-y' <br /> ��� ' <br /> H <br /> � � � � Sewer Applic�tion and Permit _ I <br /> H�� ' , . . , .� , <br /> ,o��� � � � T n 2`i S DATE 5-za-�3-' � , <br /> U7 H <br /> ��� � Service Address =94R Mnple St Utility Account No. — ' <br /> I <br /> p� �� 7423 201h St SF, I <br /> Billing Address i <br /> 4� O F.verett WA 9H2O5 10.00 ', <br /> H City, State,Zip Permit Fee $ <br />, L+ y� I Owner xobarc ,i Rro.m _ Connection Charge <br /> Ny <br /> �y�+ � Connection by Trunk $ � <br /> ���d� Lateral $ �i, <br /> t��+ I Address <br /> '�� Tolai Connection Charge $ <br /> ta <br /> i 334-793v Utility Development Fee <br /> � I Phone <br /> �' Legal Description: Water $ <br />� <br />� I �� � Lot Sewer $ �' <br /> p i Block Total Development Fee $ � <br />� I Plat <br />, i �� I Unplatted Description: Sewer Bond District <br />, � <br />� <br /> Abutting Lot Line <br /> +� N, S, E,W fl. <br />! 'i ��1 � <br />� I Type ot Permit ��P off Approved By <br /> Mj� <br />' � '�� Remarks Issued 0y ; <br /> i 1 ( � <br /> �' � Cuslomer Signature'� `'�` "� � �rT` <br /> � � <br /> � IMPORTANT4 <br /> ����. � <br /> CALL 1-800-424-5555 48-HOURS <br /> i PRIOR TO DIGGING ,�/ <br /> Inspeclioi. By �'" �"�"`�"� <br />, � CALL 259-8810 FOR INSPECTION �� ��,��q� <br /> ( Date Inspected <br />, I SEE SKETCH AttACHED � � , <br /> INSPECTION . :_ 3� ) 1 <br /> i <br />