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CHART N0. — <br /> I everett � <br /> �, SPn-F �o �>oslr'it� S-rS-q� <br /> I G' <br /> ! <br /> t <br /> `� <br /> m <br /> u <br /> Cit of Everett `" � �R � � � � � � <br /> Y y� �;� � p � � 4 <br /> Y+O� � J ^ f� � �� <br /> I!': �/` w r� e� � <br /> .w � <br /> Sewer Application �d Pgr�.it � �" <br /> �! upS ` � . <br /> 4J`.U.{] L'fi � i yZ ! •�(J� � � <br /> ` � S:C 'JJ � JL i� .� Vi = '4 <br /> n�. 27894 DATE � <br /> Service Address 6302 let Lzive S.II. Utility Account No. <br /> Billing Address 5�an ue he,.� ie�� <br /> City, State,Zip Permit Fee $ ao nn <br /> Owner Connection Charge <br /> Connection by Trunk $ }}y,-�---- <br /> Address Lateral $ <br /> Total Connection Charge $ i1p.,p0 <br /> Phone _ Utility Development Fee <br /> Logal Description: Water $ 179.OU <br /> Lot �� Sewer $ �� <br /> Block Total Development Fee $ , <br /> Plat g����i TYTTIf`P <br /> Unplatted Description: Sewer°�nd District <br /> Aburiing Lot Line <br /> N, S, E,W n. <br /> TypB Of Peffnit �sa�+ Cnnnwr�inn AppfOv2d By <br /> Remarks _ Issued By <br /> Customer Signature <br /> IMPORTANT! <br /> CALL 1-800-424-5555 48•HOURS <br /> PRIOR TO DIGGING <br /> Inspection By ���� <br /> CALL 259-8810 FOR INSPECTION <br /> Date Inspected �'OtT'�i'/ <br /> SEE SKETCH ATTACHED NO. z789� <br /> INSPECTION <br />