Laserfiche WebLink
ay <br />axx <br />�HN <br />rn H <br />OH <br />HMS <br />0Y ❑gn❑ <br />> H-3 1 <br />HH <br />gW <br />H <br />A tj rA <br />j9t� <br />zHCA <br />H O rn <br />i <br />C:) <br />41ft an, <br />I 'UM <br />T�•C�r .sYf.i',`:V�`Ri`r.P_�`: r.v,�'T�.�;'',��.,f i_?-rauti F.. <br />a <br />r- <br />Sewer Application <br />29260 DATE <br />2933 Rockefeller <br />Service Address <br />Billing Address 1516 2nd Ave <br />City, State, Zip Seattle 98101 <br />Centnan Financial Svcs <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 <br />Remarks <br />IMPORTANTI <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 />CHART NO. -- <br />TO POSTING &'30-V <br />�r jj m N N <br />G <br />Permit Fee $ <br />Connection Charge <br />Trunk $ <br />Lateral $ <br />Total Connection Charge $ <br />Utility Development Fee <br />Water $ <br />Sewer $ <br />i otal Development Fee $ <br />10.00 <br />Sewer Bond District <br />Abutting Lot Line <br />N, S, E, W ft. <br />Approved By <br />Issued By <br />Customer Signature --� <br />r ' /o <br />Inspection By <br />Data Inspected . 7E <br />INSPECTION <br />29260 <br />