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�rj�e <br />�ay <br />,azx <br />ayv <br />� <br />� H� <br />"�� H "ii <br />yH <br />x <br />� � ri <br />��g <br />(�] Y Ci <br />zH�yH <br />r h+ H <br />gy <br />H <br />o ty y <br />��� <br />H O �� <br />�� .. <br />... � <br />�� <br />�..,,��� <br />( <br />�� <br />everett <br />� _ <br />- =; � � _ _ - <br />City of Everett - ,Y ,� - <br />:; .. .,:. _� , s _ ._, . <br />Sewer Application:ar�d:-i�erri��t = y <br />_ ;y '_, _ �:., r� c, ,c _ <br />_.� C_ - _ = f-. � 1:'"�i <br />' ", - ' ' ' _ �'i W( �. <br />,_ . . _.. _ ., .�C <br />No. 28574 DATE � i/zo/�a� <br />ServiceAddress 12C3 u:tarine vie� Lr <br />BillingAddress F9y:a;r:3o- <br />City, State, Zip � , �_ <br />Owner Por[ of L'vere[t <br />Connection by <br />Address <br />Phone _ <br />Legal Description: <br />Loi <br />Block <br />Plat _ <br />Unplatted Description: <br />Type ol Permit :7ev Connec[ion <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 />Utiliry Account No. <br />Permit Fee $ <br />Connection Charqe <br />CHART N0. <br />TO PQSTI N ,r, <br />Trunk <br />Lateral <br />Totai Connection Charge <br />Utility Development Fee <br />Water <br />Sewer <br />Total Development Fee <br />3U.bti <br />$ <br />$ <br />$ <br />$ <br />$ <br />$ <br />__'�'�-D%9 �- <br />167. tt6 <br />610.41 <br />SewerBondDislrict I (rerirF.a1 <br />Abutting Lot Line <br />N, S, E, W ft. <br />Approved By _ <br />Issued f3y �B <br />Customer Signawre <br />, � �, /' ,� <br />Inspection By �� �����" <br />Date Inspec�ed � — S %7� <br />INSPECTION <br />No.28574 <br />-= 1: <br />r' <br />