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CHART NO. <br /> everett <br /> 10 ei?S�TING � 1 �(�'�il, s���� I�.� �c�rf,� <br /> ss/ 3a/A� . <br /> City of Everett <br /> Sewer Appiication and Permit <br /> Ho. 2 8 3 7 9 DATE A..an�t 12, i ooi i4't L',';;i t[l::'Cn'�N idm(iY,i:.i tFt !i� <br /> ; <br /> li4Ut.�0'31'i <br /> Service Address +�+�+ – �t xoa.s& Utility Account No. k��1{�;t ;.;�y.y�i <br /> ;.1�1R)^f;-.iy <br /> BillingAddress p�^� M•*��*-^ �^--��• F.�af.L' ti5p,ia1 <br /> City, State, Zip �--�,,�,+•a�,�;�gga76 — Permit Fee $ 30.��111 �'''�'��1 <br /> � _:� �.:�'i�A�— <br /> Owner ��iO° HO�°� Connection Charge Citl:Ca; �•I US.iMJ <br /> Connection by Trunk $ �jg,�.. <br /> Address Lateral $ <br /> 'fotal Connection Charge $ 330.00 <br /> Phone �a7-9e93 Utiliry Development Fee <br /> Legal Description: Water $ 179.00 <br /> Lot Sewer $ a�� ^^ <br /> Block Total Development F3e $ ste_nn _ <br /> Plat N�ridiin n1. <br /> Unplatted Descriptfon: Sewer Bond District y� *** <br /> Abutting Lot Line <br /> N,S, E,W ft• <br /> Type of Permit Approved By <br /> Remarks Issued By •* a+�*+ � <br /> CustomerSignaWre _ <'f �� <br /> IMPORTANT! <br /> CALL 1-80Q-424-5555 48-HOURS <br /> PRIOR TO DIGGING � <br /> CALL 259-8810 FOR INSPEC'TION Inspection By �-,� 'c�'�"`� <br /> Date Inspected - <br /> SEE SKETCH ATTACHED No. 28379 <br /> ihsPEcrior� <br />