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CHART NU. — <br /> everett <br /> ,J ` <br /> ,L.�-, `t� ,;.>s�,,,,a <br /> . � <br /> '� '•�„/ <br /> � a� � � Q �3 a �3 �? � � <br /> City of Everett :�, � ' � .r � o o � <br /> ::; �. , µ: ; � <br /> `, ., ,» � � ... ;� <br /> �y » .,. <br /> Sewer Application a�n� �Pe�rr�it � - " <br /> � , _, � �- �: <br /> � ;� � - <� � � � - :� �, <br /> � .. ju ¢ � ,� � � r <br /> � '� W � '� �al J iC (Jl � � � � � <br /> N0. Z�g� 5 DATE <br /> . <br /> Service Address — �+�'+ �� T+� � Uliiity Account Nr <br /> Billing Address , <br /> Ciry, State,Zip � Permit Fee $ <br /> Owner Connection Cha�ge <br /> Connection by �-��z �a���"" � Trunk $ � <br /> Address Latoral $ <br /> Tota�Connection Charge $ 110.00 <br /> Phone — Utiliq� Devalop:nent Fee <br /> Legal Description: Water $ i�o nn <br /> Lot Sewer $ , <br /> Block — Total Cevel�pment Fee $ , <br /> Plat <br /> Unplatted Description: Sewer Bond District <br /> Abutting Lot Line <br /> N S� E�W ft. <br /> Type of Permit Approved By_ <br /> Remarks Issued By <br /> Customer Signature <br /> IMPORTANT! <br /> CALL 1-500-424-5555 48-HOURS <br /> PRIOR TO DIGGING �/��;�� / <br /> Inspection By •-�"'j 'i— <br /> CALL 259-8810 FOR INSPECTION � �r _ ,,� <br /> Date Inspec;ad <br /> SEE SKETCH ATTACHED No. 27935 <br /> INSPECTION <br /> i <br />