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evereil <br />�e <br />City of Everett ' as <br />Sewer Application and Permit <br />NO. 28228 DATE r�rTl 2■ 13�� <br />Service Address11-_Y�tytwis— <br />Billing Address - — <br />City, State, Lip —�: 1stt, wA 9^ao t <br />Owner <br />Connection uy __j�wrj:earr-r�eRhee— <br />Address __A" -- <br />--- A9— <br />Phone <br />Legal Description: <br />Lot <br />Block <br />Plat <br />Unplatted Description: <br />Type of Permit <br />Remarks <br />IMPORTANT! <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGPNG <br />CALL 259-8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Utility Account No. <br />Permit Fee $ <br />CHART NO. <br />-Io Fc-slz� n y <br />.q-zS-3t <br />Connection Charge <br />Trunk $ <br />Lateral $ <br />Total Connection Charge $ <br />Utility Development Fee <br />Water $ <br />Sowe: $ <br />Totai Development Fee $ <br />Sewer Bond District <br />Abutting Lot Line <br />N, S, E, W — <br />__ Approved By <br />Issued By J FocT�l <br />Customer Signature <br />Inspection By <br />Date Inspected _ <br />IV,! LCTION <br />NO. 28228 <br />ft. <br />