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everett � <br /> CHART NO. <br /> 5,.�� � �,,.S,C;,� <br /> _ �/3a/�, <br /> City of Everett __ ; '°` � � �; � ' � ' �: :_ <br /> ; r� o � � c� ;� :: o i � = 4ho� /D/� / <br /> = �, � � :-- :L ; ,J , 6 �/ <br /> �, u> � <br /> Sewer Applicatior� ahd P..er°r�itw _ 1 � <br /> _ , .. <br /> r, ; <br /> a, . _ � 1 . =. � - <br /> � �` i -• .� z - -'°� <br /> '. �:, w ,i ..� k� ... � .:. � ' <br /> N0. 27964 DATE �=pb,. �, laso <br /> Service Address 6Z0o �ea—ec ga Ut'I�ty Account No. <br /> Billing Address <br /> ( City, State, Zip . Permit Fee $ �0 00 __ <br /> IOwner , _ . Connection Charge <br /> Co�nectionby __ h��ol�r �M�..�.�� Trunk g i�n ep <br /> Address — Lateral y _ <br /> Total Connection Charge $ _ii n_on <br /> Phone �g} 8866 Utility Development Fee <br /> Legal Description: i�Jater $ <br /> �79.99 <br /> Lot <br /> Sewar $ �T3 00 <br /> Block Total Development Fee $ 65e 99 <br /> Plat <br /> Unplatted Desc!iption: Sewer Hond District _���_ <br /> Abutting Lat Line <br /> N�S� E� `� ft. <br /> Type ot Permit _ Approved By <br /> Remarks �ssued By <br /> _ Cu:t�mer Signature � <br /> IMPORTANT! <br /> CALL 1-800-424-;555 48-HOURS <br /> PRIOR TO DIGGING � <br /> CALL 259-8810 FOR INSPECTION Inspection ey "� <br /> Date Inspected �-1� �� <br /> SEE SKETCH ATTACHED NO. Z7�C� A <br /> wsn�cnoN <br />