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i <br /> CHART N0. <br /> everett <br /> � S Pf� � p�s-F, .,y 6/s/�, <br /> :� <br /> a <br /> � Q � � g � 3 � � �' <br /> City of Everet� � � � .,. o � � a : <br /> ., � `� , <br /> y i W n. :J M ry � <br /> Sewer �►p�ilicatibn.a��.d�� Permit <br /> ,, :� � � <br /> � x ;� � � � � � � �: �- � <br /> ,;� , _ <br /> No. �27934 � � �DATE ~ � � � , <br /> Service Address 61a� — •—�n- Utility Account No. <br /> 5illina Address <br /> Ci:y, State,Zip 3, �+, � �"^"� — Permit Fee $ �� �D <br /> Owner Connection Charge <br /> Connection by Trunk $ _+ ^ — <br /> Address Lateral $ <br /> Total Connection Charge $_ �'� �^ <br /> Phone Utility Development Fee <br /> Legal Description: Water $ —�g�go — <br /> Lot Sewer $ aJl 00 <br /> Biock Total Develop�nent Fee $�5g,^^ <br /> Plat <br /> Unplatted Description: Sewer Bond District �^^a r <br /> Abutting Lot Line <br /> N,S, E,W — n. <br /> Type af Permit New :aonactiaa Approved By <br /> Remarks Issued By <br /> Customer Signature <br /> IMPORTANT! <br /> I <br /> CALL 1-500-424-5555 48-HOURS <br /> PRIOR TO DIGGING J�'��`� . <br /> Inspection By — <br /> CALL 259-8810 FOR INSPECTION S_�y� _ �� <br /> Date Inspected <br /> SEE SKETCH ATTACHED N0. 27�3�I <br /> INSPECTION <br />