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CHA�T N0. -- <br /> ' everett _ ,Se �� �b Pns�,w� C���-5/ <br /> City of Everett - 4� � <br /> �. ,_ <br /> Sewer Application and P��mit <br /> J � <br /> ��i � � � <br /> ; 'r = <br /> .- . . i.. _ <br /> NO. 28299 DATE _� ��j �o9z - <br /> Service Address — Utility Account No. <br /> Billing Address =�' <br /> City, State, Zip ��tt tfa 9630� Permit Fee $ 30 a0 <br /> Cwner Connection Charge <br /> Connection by Trunk $ <br /> Address ss+° s3sd al Cr Lateral $ <br /> Total Connection Charge $ -y <br /> Phone _ Utility Development Fee <br /> Legal Description: Water $ <br /> Lot ���� Sewer $ <br /> Block Total Development Fee $ 'o' <br /> Plat ��'• �itiiM <br /> Unplatted Descriptfon: Sewer Bond District <br /> Abutting Lot Line � <br /> N,S, E,W tt• <br /> Type ot Permit y�.�,��t;� Approved By <br /> Remarks s�ci�tinq lwae. I.iD �24 Issued By - -- -� :�,�— <br /> Customer Signature <br /> IMPORTANT! <br /> CALL 1-500-424-5555 48-HOURS <br /> PRIOR TO DIGGING /� <br /> Inspection By / f �`f� - <br /> CALL 259-8810 FOR INSPECTION / � <br /> Date Inspected ����( �/ <br /> SEE SKETCH ATTACHED No. 28299 <br /> insPecTioN <br />