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CHART NO. <br /> everett "' <br /> _ �Fn� '�r �tlS��a�� <br /> ti g/3Q�ql <br /> s <br /> G <br /> Cfty of Everett� � g � � ` � � � � � <br /> �ar_. q .Y G C� C? = O ;" <br /> � `; .�'.. ..: `� �. .: .e. — a`.� � <br /> Sewer Ap�licati�n�an�;?Permit <br /> , <br /> � � � � � � <br /> ..a'i a � '� 'f Ji � � � a .� � � <br /> NO. �g��� � � DATE_ T -" _ <br /> Service Address ;�—�-sr as - Utility Account No. <br /> Billing Address —��if�33 <br /> City, State,Zip , Permit Fee $ u+ oo _ - <br /> p�y�e� Connection Charge <br /> Connection by Trunk $ _.-ilo.00- <br /> Address Laterat $— <br /> Total Connection Charge $ »o M► <br /> Phone _ 5t6-3%9 Utility Development Fee <br /> Legal Description: Water $ +'ro eo <br /> Lot �_ Sewer $ , <br /> g��k Total Development Fee $�5g, <br /> Plat �eermd il�rra.•. -- — <br /> Unplatted DescripUon: Sewer Bond District ^M'" _ <br /> Abutting Lot Lins <br /> N�g� E,yd ft. <br /> Type of Permit y� �......-.�«;� Approveo By <br /> Remarks Issued 6y <br /> i <br /> Customer Signature <br /> IMPORTANT! <br /> CALL 1-500-414-5555 48-HOURS <br /> PRIOR TO DIGGING <br /> Inspection By � <br /> CALL 259-8810 FOR INSP6CTION �-- �, �.� <br /> Date Inspected S `� <br /> SEE SKETCH A7TACHECi No. 27931 <br /> INSP[CTION <br />