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� <br />� <br />everett <br />� <br />City of Everett <br />TO POSTING � � <br />Sewer Application and Permit <br />NO. `Z$692 DATE ��rjt �n �nm <br />ServiceAddress +��c ��—•—� <br />Billing Address -- <br />Ciry, State, Zip <br />Owner _ o+� n3q�rr <br />Connection by _ ar — <br />Address <br />Phone <br />Legai Description: <br />Lot <br />Block — — <br />Plat <br />Unplatled Description: <br />Type of Permit nL17sx7�7'IOx <br />Remarks �4r���`�'� � s �c�P <br />5e�.�.,� ., �.Q•• d�--4�,�.�(.. <br />IMPORTANT! <br />CALL 1-B00-424-5555 48-tiOUR� <br />PRIUfl TO DIGGING <br />CALL 259•8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />�C�,'a7��•"��ar sF k'..�'t �`j�. z�i, .. �.f . '�r:.:�r�{�.rf. <br />Utility Account No. <br />Permit Fee b <br />Cunneclion Charge <br />Trunk <br />CHART NO. <br />p:• �1, ��,� <br />ti(�CL 51.4� <br />���s� <br />GGSki <br />Lateral <br />Total Connection Charge <br />Utiliry Deveiopment Fee <br />Water <br />Sewer <br />Total Development Feo <br />Sewer eond Disirict . <br />Abutting Lot Line <br />N,S,E,W — <br />Approved By <br />IsSued By * �^ <br />Customer SignaWre _ <br />$ <br />$ <br />$ <br />$ <br />$ <br />$ <br />:,e''.'�tl C�p!)Fi;i.a�;9 4!.{S <br />' � ��. ixT <br />�, � i). O[1 <br />Inspection [3y � �"�/ly�`� <br />Date Inspected L "�� — �` Z <br />INSP�CTION <br />No. 28692 <br />� <br />i <br />t <br />; <br />