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t <br />i <br />� <br />t <br />everett <br />City of Everett <br />To PosT►.Nc _ � 5 9 � <br />Sewer Application and Permit <br />NO. 2$ J� q DATE ,�,w� 2 s i�9� <br />Service Address ' «��--"" <br />Billing Address � "-'- `;� <br />City, State, Zip <br />Owner Poct of �wrett <br />Connection by Harnev F Nusmi OQnnt. <br />Address <br />Phone '+4� insf <br />Legal Description: <br />Lut <br />Block <br />Plat <br />Unplatted Description: <br />Type of Permit NEc� WNNECTION <br />Remarks <br />IMPORTANT! <br />CALL y-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Utility Account No. <br />CHART NO. <br />ui .. � :,:�-.,:,, �,:��a,:: � � , <br />;;i{�''t(���(l' �[�56Y (�(y� <br />�.Y.WLR YjL��IK� <br />C,lEt7' S.;O.I'� <br />Permit Fee $ 30 00 — <br />Connection Charge <br />Trunk <br />Lateral <br />Total Connection Charge <br />Utility Development Fee <br />Water <br />Sewer <br />Totai Development Fee <br />Sewer Bond District <br />Abutting Lot Line <br />N, S, E, W _ <br />Approved E3y � IIrooks <br />Issued By <br />Customer Signature <br />$ <br />$ <br />$ <br />$ <br />$ <br />$ <br />n. <br />i����� `� 7" <br />L _> <br />��. �,,,;, >f ✓��tc.� <br />�i�� ���LL� C,i'"' `', �'T'��' <br />Inspection By — <br />�, ,� �,,,..��. <br />Date Inspected � `�3 - � � <br />INSP[CTION <br />rvo. 28569 <br />