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r� <br />9H <br />R)7�x <br />>Hxxc~n <br />H H ZH <br />�C Z <br />0=0 <br />�H� <br />N H <br />H r <br />q <br />0�g <br />n. o <br />H <br />zH <br />Sewer Application and Permit <br />2903 <br />DATE <br />Service Address <br />1612 McDougall Ave <br />Utility Account No. -- <br />Billing Address <br />same <br />City, State, Zip <br />Everett WA 98201 <br />Permit Fee $ <br />Owner — <br />David Bargalien <br />Connection Charge <br />Connection by <br />batter 6 Daughters. <br />Trunk $ <br />Address <br />Lateral $ <br />Total Connection Charge $ <br />Phone <br />Utility Development Fee <br />Legal Description: <br />Water $ <br />Lot <br />Sewer $ <br />Block <br />Total Development Fee $ <br />Unplatted Description: <br />Type of Permit <br />Remarks <br />Alternt!-. <br />IMPORTANTI <br />uj CALL 1-800-424-9555 48-HOURS <br />PRIOR TO DIGGING <br />I <br />CALL 259-8810 FOR INSPECTION <br />Sewer Bond District <br />Abutting Lot Line <br />N, S, E, W — <br />Approved By <br />Issued By _ <br />Customer Signature <br />ft. <br />Inspection 0� ✓�— — <br />Date Inspected z yj <br />SEE SKETCH ATTACHED C <br />INSPECTION - 'j t `' <br />M <br />