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CHART NO. <br /> ieverett <br /> ��� � CG �JvSR� I <br /> ,a�y � G/�,RI I <br /> a y� City of Everett II <br /> y z" � �ew�r qpplication and �P�rr�it ' <br /> O 5O <br /> �J H'i1 i <br /> V1 H <br /> �i ot� j NO. `Z7�� � DATE _1t1lt��ro� _ ' <br /> HC � I <br /> H �g �i Service Address ��' ^ ' "� �} Utitity Account No. <br /> 5�. � i �, <br /> z �.,� I Billing Address _ - <br /> r H y �' Ciry, Slate,Zip � ` .� �----- Permi;Fee $ '" �^ <br /> gCy N I Owner - Connection Charge <br /> G eae ey nnt, nc lt . t�� �I <br /> y � ( <br /> �j �� Connection by �`�i �.-•''�^�^�� — Trunk �— <br /> i <br /> `3 ��' Address Lateral � � <br /> �' Total Connection Charge $ 110.�0 I <br /> I Phone Uliliry Development Fee I <br /> � Wator $ 179.OU <br /> Legal Description: I <br /> (,� ` � 471.On � <br /> � Lot s� Sewer � i <br /> ' I Block Tolal Development Fsz $ �»0.CQ <br /> ��. � I Plat �-��_:=� � I <br /> � Sewer Bond Dis�rict <br /> � Unplalted Description: I <br /> � � i <br /> ( ` � Abuttinc� Lat Line i <br /> i <br /> �I — N, S, E.W r' � <br /> �4 I I� Type ol Permit _ Approved By <br /> i <br /> � Remarks _ Issued By I <br /> 1` g � <br /> � ___ Customer Signature <br /> � 'i IMPORTAN7! <br /> I CALL 1-800-424-5555 48-HOURS I <br /> PRIOR TO DIGGING ��� � � <br /> Inspection By _ <br /> �I CALL 259-8810 FOR INSPECTION �_�_s � <br /> Dato Inspecled <br /> , SEE SKETCH ATi'ACHED No. 279 l3 <br /> �� !hlSPtl.l ILi! <br /> -� <br />