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CHART NO. <br /> euereft <br /> City of Everett <br /> Sewer Application and Permit <br /> NO,ZHO$3 DATE 3- I 5 - �j <br /> Service Address �4 �e..? �v Ukp� Utility Accouni No. � <br /> Billing Address <br /> City,State,Zip Permit Fee $ <br /> �Owner Connection Charge <br /> Connedion by C i t�! O� FVP_ h��"� Trunk $ <br /> Address Lateral ; <br /> Total Connection Charge $ <br /> Phone Utility Development Fee <br /> Legal Description: Water $ <br /> Lot Sewer ' ` $ - <br /> Block Total Development Fee E <br /> Plat <br /> Unplatted Description: Sewer Bond District —. <br /> Abutting Lot Line <br /> N,S, E,W ft. <br /> Type oi Permit Ro_DA�y��� ��i r> . _� Approved By <br /> / ' <br /> Remarks r i C�y; C r • � �o ,C_ Issued By �j�� � � Il e� — <br /> M��f�L.i D L�.v�= r,�� �L CustomerSignature <br /> y" P VC• �MPORTANTt /Y161'N �/ � d�'�F <br /> �;�...�� � �-_ � ' �,!_zP , <br /> CALL 1-800-424-5555 48-HOURS `� c � ��L /-/ ' � zc� <br /> PRIOR TO DIGGING � �j�� � /v o f /"rrN � /ST// <br /> Inspection By , � �� <br /> CALL 259-8810 FOR INSPECTION , <br /> Date Inspected ��•� 7 � /`'/ <br /> SEE SKETCH ATTACHED NO. Z S O H 3 <br /> ���ri����:� �`-i�_i_r,��, <br />