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CHART NO. <br /> everett <br /> Se.� -f� cka��,.u1 <br /> �$—A-( <br /> s�-16 -4� <br /> City of Everett <br /> Sewer Application and Permi� <br /> N0. Z 7 9 S� DATE �..«..*-- > >oo� <br /> Service Address , Utility Account No. <br /> Billing Address , <br /> Ciry,State, Zip —.��. Permit Fee $ �a� <br /> Owner � �� Connection Charge <br /> Connection by Trunk $ , <br /> Address Lateral $ <br /> Total Connection Charge $ ����_ <br /> Phone Utility Development Fee <br /> Legal Description: Water $ . <br /> Lot Sewer $ •� ^^ <br /> Block — Total Development Fee $ . <br /> Plat 10rU3/�!0 0=44{U� IX10AHi457 ►T 1 <br /> ! <br /> Unplatted Description: Sewer Bond District ��'�j <br /> [�DG 4•S,`k?.� <br /> Abuping Lot Line NLLXi N�5.00 <br /> t�C1:H 940.D0 <br /> N� S� E�W Cts�tCtl iY.SH rt. <br /> iiF�JN'; i�0.W <br /> Type oi Permit y,�.p�;�s� Approved ey �� � ` <br /> Remarks Issued By . ��TF.I:: �1.tlS.[X3 <br /> t�lkllk:'IS`i7 <br /> _ Customer Signature `��Q'F' ���' '� <br /> E�Illlll i�3Q.f10 <br /> IMPORTANT! ��'1-`' ���•� <br /> CfiLG; d172o.57 <br /> CALL 1-800-424-5555 48-HOURS <br /> PRIOR TO DIGGING <br /> CALL 259•8810 FOR INSPECTION Inspection By ' <br /> Date Inspected 2 <br /> SEE SKETCH ATTACHED No. 27957 <br /> INSPECTION <br />