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everett <br />�ity of Everett <br />� <br />, <br />;�, <br />fi <br />xe <br />� <br />� <br />;� ';� g � R� <br />, <br />� �_.� �� � '3 �� <br />r.� .�. . .. . <br />� <br />• <br />Sewer Application�a.r�d����ut <br />. v CC CJ Cz > > f �..: <br />Ci ��}��3�'v-.GU�w <br />(; 1+�.�C� C :��':il �= <br />NO. 2gs� 7 DATE� ..i �}��qg� -- <br />Service Address � ` ` " �v� <br />Billing Address <br />City, State, Zip __ <br />Owner <br />Connection by <br />Address <br />CHART NO. <br />TO POSTING �-z 5-93 <br />Utiliry Account No. <br />Permit Fee $ � sr <br />Connection Charge <br />Trunk $ <br />Lateral $ <br />Total Connection Charge $ <br />Phone .74�! �" Utility Development Fee <br />Legal Description: Water <br />Lot Sewer <br />Block Total Development Fee <br />Plat <br />Unplatted Description: <br />Type of Permit Crn off <br />Remarks <br />IMPORTANTI <br />CALL 1-800-424-5555 48-HOURS <br />'�RIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Sewer Bond District <br />Abutting Lot Line <br />N, S, E, W _ <br />Approved By — <br />Issued By <br />Customer Signature <br />$ <br />$ <br />$ <br />� �,,�� .�,�� _ <br />n � <br />� j�� <br />Inspection By _ <br />Date Inspected <br />INSPECTION <br />No. 28617 <br />� <br />ft. <br />