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CHART NO. --- <br /> evereti I <br /> i [o P��S-1, ,,� ���i6/a� �� <br /> � = �� <br /> �t7 H � _ ,� - _ ' ' � � .� _. - I <br /> ��� � CityofEverett - `• - -• : _ _ :? � :' � <br /> .o�� - ;� -. - . . . .:, �' ::: =�. I <br /> ayy ! Sewer Application anc� Perr�i#=� � � <br /> H >a - . � _ _ o ._ �_ �'I <br /> yz~ ' � - - - - - - �4' ^ 'i= <br /> K O i _ "_. :' _ ._ ' . .'.� _ _ yn '� <br /> � H� i NO. 2 1��3 7 DATE _�uc,vcir 'o. ion� - -- -- ' i <br /> fA H I <br /> � p� I Service Address r,�� _ ,..., ���«-- Utiliry Account No. -- — � <br /> yd i i <br /> � � Billing Address � <br /> H �g I 30.00 <br /> H` � City,State, Zip r�+P** �A Permit Fee S __ <br /> r y� I Owner �..p�y..p�_�„ Conneclion Charge I, <br /> g �'~, I Connection by same Trunk $ 110.00 I <br /> c� t7 m I <br /> � r�� Address Lateral $ <br /> H O Cyi+ i <br /> Tolal Connec�ion Charge $ ylp nn ' <br /> Phone _r�yg6P— Uliliry Development Fee <br /> I� Legal Description: Water S _�_o� <br /> I i <br /> i i <br /> Lot sn Sewer $— ,00 i <br /> ��""'� I Block Total Development Fee $ —g}3=gg li <br /> �� <br /> Plat tdgeNood 2errecn i <br /> (�' ') Unplatted Description: Sewer Bont Disirict � I <br /> m ' Abulting Lot Line I <br /> �� � — <br /> 1_ N.S, E,VJ . ft. <br /> � <br /> IType of Permit xe r..n n�++�n Approved By <br /> (� � <br /> e� ( Remarks Issued By.—_—TTa <br /> _ —_ CuslomerSignature I <br /> 1 Q�j �I <br /> IMPORTANT! <br /> a'�..� I CALL 1-800-424-5555 48-HOURS <br /> � PRIOR TO DIGGING �'� I <br /> � In;pection By /�/v/ I <br /> CALL 259-8810 FOR INSPrCTION � <br /> � Dato Inspected ��J y� <br /> � SEESKETCHATTACHED N0. 27�97 <br /> il <br /> ; i;. ! <br /> : <br />