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._, `. �: <br /> CHART N0.' ---- <br /> � everett � <br /> se�� In�,o��,..� s �s-4j <br /> e _y <br /> � <br /> ���' _- rt � � �;:� Q � � s � � <br /> City of Evereti �_ � <br /> >H ,. ' .. ... - . . _ 'K <br /> ,ozx - _ - <br /> rx� � Sewer App�catuan�-ar�d.Permit <br /> " t''y 3 i -- - - - ',� ; : . _. I <br /> K o I y -;` ' � -_ _ '; � ^ <br /> y - � - t <br /> � H� NQ. 2�Q� � � DATE ���s�qq � <br /> fA H <br /> � �� Service Address , Utiliry Accounl No. -- I <br /> H C7 <br /> H � Billing Address �. <br /> �• � Ciry,State,Zip --, � ^�3g3-- Permit Fee S .�p_no <br /> r '�� Owner _ Connection Charge <br /> g y r, ' Connection by Trunk $ . <br /> c� C w _ <br /> Address Lateral $— <br /> � �y Total Connection Charge $ »� �� II <br /> �-3 O f/� <br /> Phone _ Utiliry Development Fee � <br /> ILegai Description: Water g _ I <br /> Lot — si Sewer $--5"° ^^ <br /> + � Block Total Development Fee $�,�}.g;,— <br /> 1 � <br /> Plat ��IYrrat <br /> �^°� �, Unplatled Description: Sewer Bond District <br /> � � Abutting Lot Line <br /> N,S�E�W ft. <br /> 1 Type ot Permit Approved By <br /> ec m <br /> � ��j Remarks Issued 8y , <br /> Customer Signature ,_ <br /> _,, 1 IMPORTANT! <br /> (�. ` CALL 1-800-424-5555 48-HOURS <br /> �.I 1 I PRIOR TO DIGGING o�' ' / — <br /> IInspection By ��'`"`� � <br /> „ i CALL 259-8810 FOR INSPECTION � .�r c� i <br /> Date Inspected <br /> I <br /> I SEE SKETCH ATTACHED NO. �7�0� <br /> I I�,.�'f��_L 1���.I <br />