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i <br /> CHART NO. — — <br /> i everett Se�t �v r�s!-,�� f3/3%q I <br /> `4 <br /> 4 <br /> City of Everett � � � � � R `� � � � <br /> �i. �l L O�1 G C� J C� l'� � <br /> > �Y '.� Cn M 1•3 F^� .-r � p � <br /> U1 �+ a .H n! r� <br /> f•1 � <br /> Sewer Applicatior� a�d P� 'r��t a <br /> ^ � ��l 1 ( 11 � .i �' • <br /> C7 � � � � �" � �j � C] [.� � � � . <br /> � Fi � :� v ` r � � .� � i <br /> NO. 27�a.� DAT� __ i.,qn•c zt, ,00n <br /> Serv(ce Address yp�����_ Utility Account No. — <br /> Billing Address <br /> City, State, Zip — � Permit Fee $ _ �•� <br /> Owner Connection Charge <br /> Connection by Trunk $ 370.00 <br /> Address Lateral $ <br /> Totat Connection Charge $ <br /> Phone � �� Utility Development Fee <br /> Legal Description: Water $ ��g,pp <br /> Lot S,] Sewer $— ��� -� <br /> Block Total Deveiopment Fee $ 650.00 <br /> Plat <br /> Unplattod Descriptio�+: Sewer Bond District �nd z <br /> Abutting Lot Line <br /> N, S, E,W ft. <br /> Type of Pt rmit _ x�r ��truction Approved By <br /> Remarks _ Issued By �y�,m� +u*_–� <br /> Customer Signature � <br /> IMPORTANT! <br /> CALL 'I-800-424-5555 48-HOURS <br /> PRIOR TO DIGGING / <br /> � , <br /> C�LL 259-8810 FOR INSPECTION Inspectinn By �� ' I <br /> , <br /> Date Inspectsd � <br /> SEESKETCHAttACHED No. Z7S�� <br /> wsr�r-crioN � <br />