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�c�;n�T n�a _ - – — — <br /> everett � <br /> ti�H �, � I TO P - �/� ,� <br /> ;,r•�, OSTINC___.�_ <br /> A�x i� City of Everett <br /> >H Cn <br /> y zH �, Sewer �pplicatior� and Permit <br /> K y� <br /> yc�'i�� I NO. �R�7S DATE �,•,_12, �noi _ — i <br /> � ' <br /> :z z 7�13 er Rid Ad �C�/2U(St °:i��f:ri �.n.�,l�����i'.��..�, . <br /> � y r1 � Service Address — �'p � — Utiliry Account No. <br /> I:Ik�lCbt,'t'�i <br /> �VCn'7� �, Billin Address — Po '�^Y 5308 ', <br /> 9 ILIiG i�r`��".'+l <br /> i r-+� City, State, Zip — r...e...�r ��n ne�nr. Permit Fee $ �E�' '.!��.00 ' <br /> a y I i .� �, ��.,.�.i i <br /> r �'"� Owner _ Connection Charge �; `��}� •�� '� I <br /> g yH � � 1 �i�L9.'�' :.�ii.�{U <br /> � d❑�' Conneclion by L�" � Trunk �����4� <br /> 3 [�1t" '�. i1i1111' st �4?.G'.1 <br /> z y� I hddress Lateral �;(iCa'$;�''3 <br /> H Otn I �_Flk�i� ;�J].(�q <br /> _ _ To�al Conneclion Chargg�., ,$, <br /> Phone ��p Utility Development Fee � I;i� i , �. ; ,i;�'� <br /> Legal Description: Water $ 179.DU <br /> Loi � — Sewer $ e�i nn <br /> I�" " <br /> � � I Block Total Development Fee S 650.00 <br /> i Plal Rt�1qt hwnn __ <br /> �µ �� � <br /> " "'� Unplatted Descnption: _ Sewer Bond Dislrict ����� r r.-.,��.�� <br /> Abutling Lol Line <br /> ! ! I N,S, E�W tt. <br /> Type ot Permil r . �,� Approved By _ <br /> � " I� Remarks — Issue l By ,_ <br /> I <br /> � ,,..' I _ _ — CustomerSipnature <br /> � i IMPORTANT! <br /> ��..� I CALL 1-800-424-5555 48-HOURS <br /> � PRIOR TO DIGGING G <br /> i <br /> Inspeclion By �� � <br /> � CALL 259-8810 FOR WSPECTION <br /> �I Datelnspected ?��� � '� - <br /> I SEE S�:ETCH ATTACHED rio. 2$275 I <br /> i � <br /> � <br /> :�<� . I <br /> -- :, <br />