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9Hyyc~n <br />H x� <br />� Hz <br />MH <br />[QQp H <br />H1 cli g <br />y. V <br />yzy rH3 <br />rHH <br />oC� <br />H O ryn <br />� everett <br />e <br />City of Everett <br />Sewer Application and Permit <br />NO. 28564 DATE _ ja n rngP <br />Service Address 217 1. s�lYu' ^vc <br />Billing Address ^0l; 1514 <br />City, State, Zp Lveeett WA. 98206 <br />Owner <br />Connection by <br />Address <br />Phone <br />Legal Description: <br />Lot <br />Block <br />Plat <br />Unplatted Description: <br />Type of Permit 10, C r+oi — <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 />Utility Account No <br />HART NO. - <br />TO POSTING_ <br />05i77/97. <br />4:5011 0t1 04L+i R1d. <br />1 <br />ut1oe35oas <br />ELOO <br />5455.00 <br />PLEG <br />05.00 <br />HECH <br />S60•01) <br />0 SRUI <br />$4.54) <br />ICA <br />M <br />?"Itt M <br />[AvI 1 <br />s725.00 <br />1171/5 <br />fb50.00 <br />Lxcl; <br />i19139. <br />Permit Fee $ vn <br />Connection Charge <br />Trunk <br />Lateral <br />Total Connection Charge <br />Utility Develcpmenl Fee <br />Water <br />Sewer <br />Total Development Fee <br />Sewer Bond District <br />Abutting Lot Line <br />$ - 130 np <br />$ 795.CO <br />$ 775.00 <br />$ 170 Us <br />$ 471 00 <br />$ 650.00 <br />N, S, E, W ft. <br />Approved By \ <br />Issued By <br />Customer Signature _ <br />i <br />Inspection By _ <br />—21 E <br />Date Inspected <br />INSPECTION <br />NO.28564 <br />