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I"�'•"_r--" �-'3T"\'�- . . < , .. -- . .- '_",-�^ Z.j�,� ,.•-•<T.-';,T�.-.-T ,"^-'R <br />I ' <br />; _. <br />i <br />� - <br />i � -�; <br />� 3 <br />I L r_� <br />I r � r� <br />C� • <br />f � G� �- <br />r` <br />_:1 „ � <br />i Sewer Application a�� ��Perrr�it <br />�� ��a <br />i �=, .- ;'s' � <br />I : 2 912 9 DATE ^ 3-24-93 <br />� Service Address <br />� Billing Address <br />City, State, Zip . <br />; Owner <br />! Connection by _ <br />I� Address _ <br />2920 Rockefeller Ave <br />anmu <br />Everet[ WA 98201 <br />Bill'. <br />Mr Rr r <br />P(1 Hos 8238 <br />Kirkland WA 98034 <br />Phone 514-0544 <br />Legal Description: <br />Lot <br />Block <br />Plat <br />Unplatted Description: <br />i Type of Permit <br />I <br />I Remarks _ <br />Repnir <br />IMPORTANTt <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />SEE SKETGH ATTACHED <br />Utiliry Account No. <br />CHART NO. <br />Tn posTiN� � -Z ��- <br />PermitFee $ 30.00 <br />Connection Charge <br />Trunk $ <br />Lateral $ <br />Tolal Connectfon Charge $ <br />Utility Development Fee <br />Water $ <br />Sewer $ <br />Total Development Fee $ <br />Sewer Bond District <br />Abutting Lot Line <br />N� g� E� yy ft. <br />Approved By <br />Issued By rg� c -�� <br />:�; =�. <br />�- �___---�'� <br />Customer Signaturo•.�,' -' -�'�� f �-�� <br />/ �o/` <br />e <br />\ k'�S�Q��� <br />�o <br />Inspection By _ <br />Date Inspected <br />INSPECTION <br />,:> ���z� <br />