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CHART NO. <br /> everett <br /> Sew�- � i'�-'"9 <br /> 9�z3/4� <br /> City of Everett <br /> Sewer Application and Permit <br /> NO. 2�'�� 1 DATE sepwnsr 5 is91 <br /> p4;O5,'"1 v:19iiii �b.1C41NkYloS k k S ; <br /> Service Address �"^' � r �.. sp Utility Account No. ` <br /> ilIXN1�8�'e 7.l <br /> °�E6)Il? 5 �(l.lil <br /> Billing Address <br /> ct�:n, ��o.��a <br /> City,State,Zip �- •� � °�^A Permit Fee $ �0.00 <br /> Owner Connection Charge <br /> Connection by Trunk $ <br /> Address Lateral $ <br /> Total Connection Charge $ <br /> Phone u�-�67 Utility Development Fee <br /> Legal Description: Water $ <br /> Lot Sewer $ <br /> Block Total Development Fee $ 'a' <br /> Plat - <br /> Unplatted Description: Sewer Bond District <br /> Abutting Lot Line <br /> N, S, E� W ft. <br /> I Type oi Permit Approved By <br /> IRemarks Issued By ' "'"''"'" <br /> ICustamer Signature <br /> IMPORTANT! <br /> CALL 1-500-424-5555 48-HOURS <br /> PRIOR TO DIGGING � <br /> Inspection By �'� ""�— <br /> CALL 259-8810 FOR INSPECTION <br /> Date Ins?ected �7 P/ <br /> SEE SKETCH ATTACHED NO. 2�d�1 <br /> INSPECTION <br />