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-„�:: <br /> 5 <br /> m � x <br /> � � u�"i CHART NO. -- <br /> everett �I � <br /> K y� (o I�or7',Kc� [D�/Gl4/ ,I <br /> �� � e : __ _ �� <br /> � x a �; s. a � <br /> y e City of Everett - _ - � <br /> "� g Sewer A licat�on ar�d Permit ' � � ^ �� <br /> zyH � pp _ � . � <br /> t" y . • - -' � _ ' - --�,u� ' ' <br /> _ - � _ � <br /> gdy NO. 27HSH DATE - au�,,E}E ze �19va � � � <br /> �y� Service Address — � , , Utility Account No. <br /> HO [n <br /> Billing Address ;ar ac - ve. <br /> City, State,Z�p � Permil Fee � '+� ��n <br /> .. .. , <br /> Owner �_- e _ �� Connection Charge � <br /> � Connection by �� Trunk � . � <br /> I <br /> Address — Lateral $ _ — <br /> I <br /> Total Connection Charge $��c}gU--- <br /> Phone Utility Development Fee <br /> �{�� Legal Description: Water $ i�7 ao — <br /> `� <br /> Lot Sewer S , <br /> 1 � II Block Total Development Fee $ �s� n0 <br /> � � <br /> �'� Plat <br /> � • ��� <br /> Unpiatted Description: Sewer Bond District <br /> i .�� Abutting Lot Line <br /> N,S, E,W n I <br /> �'+� 7yps of Permit 4pproved By -- <br /> I:ea �onucc[lon I <br /> Remarks Issued By <br /> . uc :t <br /> Customer Signature <br /> �� <br /> IMPORTANT! <br /> I 1 (�� CALL 1-800-424-5555 48-HOURS � <br /> l PRIQR TO DIGGING <br /> Inspection By ����j <br /> CALL 259-8810 FOR INSPECTION ��,_S._�� <br /> Date Inspected � ' <br /> SEE SKETCH ATTACHED N0. 278�� <br /> I � <br /> I �-r,�io�; <br />