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P <br />M <br />CpO pp pp C p op p p pp <br />�� y�00NSH H 1�J HHO <br />Sewer Application and Peinilt, " <br />291467 DATE <br />5923 <br />Service Address <br />442-3-3rd lor H <br />Billing Address <br />237 Elm St <br />City, State, Zip <br />Everett AA 98203 <br />Owner <br />Select Homes <br />Connection by <br />Address <br />Phone <br />Legal Description: <br />Lai 25 <br />Block uanabr� ok d1v 3 <br />Plat <br />Unplatted Description: <br />Type of Permit <br />Remarks <br />.7ev connection <br />IMPORTANTI <br />CALL 1-800-424.5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />Utility Account No. <br />CHART NO <br />POST11"' <br />Permit Fee $ 70.00 <br />Connection Charge <br />Trunk <br />Lateral <br />Total Connection Charge <br />Utility Development Fee <br />Water <br />Sewer <br />Total Development Fee <br />$ <br />$ 179.00 <br />$ 179.00 <br />Sewer Bond District ULiD <br />Abutting Lot Line <br />N, S. E. W It. <br />Approved By <br />Issued By b <br />Customer Signature, <br />Inspection By y <br />Data Inspected /— z z- - <br />SEE SKETCH ATTACHED <br />INSPECTION <br />'. 29267 <br />