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Hn � <br /> � � <br /> � � x <br /> � y �' , CHART NO. <br /> y � H �, everett ' <br /> �Cy � � <br /> �d F-i � I <br /> V1 H <br /> z <br /> � H d I City of Everett <br /> l�. ., ,".t�f7t td_ipltlwU:iG �;-i . <br /> � � g I <br /> "" " �� Sewer �pplication and Permit ;'"""`";`' I <br /> H <br /> � y� i SihG :lO.OD <br /> C-� �:� i � I; !{: 510.00 <br /> Hy <br /> � y `'^9 <br /> ty � � NO. 2 S ; �: . DATE �1py ?c. ina2 � <br /> � � r iy yo � � Service Address 3d1n ^+�ta1A^ ns�a. — Utifty Account No. <br /> Billinc�Address — - I <br /> I Ciry, State,Zip TM�r,att r; onZe� Permit Fee � <br /> -�T:.^ <br /> iOwner __���� Connection Charge <br /> � Connection by *+ - n �i+,.- • *sain Cing Tiunk $ . <br /> I <br /> ' Address ��e_,._��� � <br /> Nlan�t �tx_� Lateral $ — <br /> ! r�„rorr� vn gm0] Total Connection Charg� $ <br /> i I <br /> . �� ���^•�e 37¢-774i� Utility Development Fee j <br /> I ��� � Legal Description: Water $ � <br /> s <br /> ' ' Lot _ � <br /> � , __ Sewer $ <br /> I I <br /> ��...' Block Total Development Fee S <br /> i �� ' <br /> Plat _ <br /> I <br /> I <br /> Unplatted Description: Sewer Bond Disirict ' <br /> � �� Abuqing Lot Line � <br /> I <br /> N,S, E,W tt. <br /> �' ✓ ' <br /> ��� I Type of Permit rr.raiR � Approved By n r�...,,,, <br /> /, <br /> j Remarks _ � ^ Issued By , , i <br /> 0�� �' ` / Customr,r Signature I� <br /> � MPORTaP17! j �3, � <br /> l �~0 I. I CALL 1-500-424-5555 48•HOURS I <br /> � � PRIOR TU DIGGING � <br /> � CALL 259•8810 FOR INSPECTION �nspection By _ � <br /> , Date Inspected _ <br /> i , <br /> , SEE SKETCH ATTACHED NO. 28729 <br /> I i��: ! ; �_ . <br />