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� � � I CHART NO. — - — , <br /> p � c �, everett ; <br /> � � <br /> � � _ ; I <br /> 0 6 0 � TO POSTING_ �z-�__�-T i <br /> bN � i _ - _ _ <br /> � z � li City of Everett ' <br /> � <br /> � � R , Sewer Apptication and Permit <br /> „ _ <br /> =y M � - . . ' . � '- - <br /> F' "3 2 i _ - �. �. . ., - : . _ ._ I <br /> i <br /> � y y ! NO. 2��'_�9 DATE *�rii z i9ei <br /> „ I, <br /> O u1 <br /> C C <br /> � y N Service Address sni� vi.,.� �* Utiliry Account No. <br /> H O N I� <br /> I Billing Address —�3g-�}i�p-A. <br /> City, State, Zip TM�+•^tx-rt�:+--9H2u3-- Permit Fea $ lo.00 I� <br /> �I ' <br /> i Owner - - � Connection Charge <br /> —.�__._� .,.. <br /> Connection by Trunk $ I <br /> Address Lateral $ I <br /> Total ConneUion Charge $ -- i <br /> I Phone Utility Development Fee ; <br /> i �� i � <br /> ��+ i Legal Description: Water $ <br /> i I Lot — Sewer $— - i <br /> � +,� i Total Development Fee $ <br /> � � Block <br /> •�.,,. <br /> � Plat <br /> Unplatted Descriplion: Sewer Bond Dislrict � <br /> ', �"�- Abutting Lot Line I <br /> N�S, E,W �' I <br /> "��� I <br /> � Type of Permit Approved By <br /> i <br /> Remarks Issued By I <br /> � (�� Customer Signature � <br /> IMPORTANT! t'C���'' I <br /> 1 �� � � l�/ <br /> I +�a►� CALL 1-800-424-5555 48-HOURS �� ,� � j <br /> � PRIOR TO DIGGING ' <br /> I �rc�t;o„_ay ��,�� I <br /> CALL 259•8810 FOR INSPECTION � <br /> � Date Inspected �� � �� � <br /> � ' <br /> � <br /> �' � <br /> i SEE SKETCH ATTACHED No. 28199 I <br /> i <br /> i <br /> i � , . <br /> , . <br /> � <br />