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CHA?T N0. <br /> everett �-«-5 i <br /> S�.�f- +� ��os��n5 <br /> �a <br /> � <br /> � � t� �; � � � <br /> _ g _ S .. $ � - <br /> City of Everett _ o �� � :r � ' , ?. ? :: " <br /> � .� . :.: ;� � ,: ., �, <br /> w � . �� <br /> . <br /> Sewer Applicatia� �nd P�er�n� � �-. _ <br /> _ � � , - -� � � � = �� � , !� <br /> � � �'y". � � i � � � � � .;� _- .�' . <br /> N0. 2 7 9�9 DATE •••-�•-a �o ^�oan <br /> Service Address Utility Account No. <br /> Billing Address sl�e " *.�t a.. <br /> City,State, Zip Permi:Fee $ io 00 <br /> Owner Connection Charge <br /> Connection by <br /> L,,.}i Trunk $ llo 00 <br /> Address Lateral $ <br /> Total Conneclion Chargo $ <br /> Phone Utility Development Fee <br /> Legal Description: Water $ <br /> Sewer $ SS9 00 <br /> Lot <br /> 81�.00 <br /> Block Total Development Fee $ <br /> Plat �lLd9i� '""�aO� <br /> Unplatted Description: F 3wer Bond District <br /> Abutting Lot Line <br /> NSEW ft. <br /> Type of Permi; Approved By <br /> Remarks Issued By <br /> � <br /> Customer Signature <br /> IMPORTANT! <br /> CALL 1-B00-424-5555 48-HOURS j <br /> PRIOR TO DIGGING ' <br /> Inspection By �� <br /> CALL 259-8810 FOR INSPECTION Date Inspected �"l3" �� <br /> SEE SKETCH ATTACHED No. 27909 <br /> INSPECI IOi�I <br />