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� <br />everett <br />�:. <br />� <br />� <br />� ��� 4 =:� �; � <br />City of Everett <br />� �:, •a c ��. c �i <br />r�� � � .�-e ~ H r.M1 <br />Sewer Applicat�o�"�� �,�e�'�'i1i� =' <br />� � (�) �' i V ` �/C� Q u C'J <br />�i �����r � � �t-'�'- <br />iv�G 7:��`xx��a:7.��� <br />NO. 2 8 7 Z 6 �ATE �s� �–� ; oo ` <br />Service Address , <br />Eilling Address <br />City, State, Zip <br />Owner <br />Connection by <br />Address <br />Phone 7� •�» <br />Legal Description: <br />Lots — <br />Block ..�.5 <br />Plat ' <br />Unplatted Description: <br />Type of Permit <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 />Utility Accaunt No. <br />CHART NO. <br />��'� �'OSTING ,-Is-vs <br />-� .- <br />� � .� <br />4� d <br />�: �. <br />:n <br />=u <br />: � <br />Permit Fee $ �� 00 <br />Connection Charge <br />Trunk <br />$ <br />Lateral $ <br />Total Connection Charge $ <br />Utility Development Fee <br />Water <br />Sewer <br />To;ll Development Fee <br />$ na�.00 _ <br />$ 1 179.00 _ <br />$ �,F�s_on <br />Sewer Bond District Northend <br />i+butting Lot Line <br />N, S, E, W <br />Approved By <br />Issued By <br />Cus�umer Signature <br />� <br />�� i <br />Inspection By � <br />Date Inspected � `� - � <br />INSPECTION <br />No.28726 <br />