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C:j <br />ft'W <br />-Mk'� <br />everett <br />e <br />City of Everett <br />CHART NO. <br />TO POSTING ic,z <br />Sewer Application and Permit <br />NO. DATE <br />Service Address 3619 Pucker Ave. <br />Billing Address l^oLrtatm --- <br />Lwerett, :4A 913201 <br />City, State, Zip <br />Owner _r+r.7,r „Qr^«« IN— 't,rt^n e2t <br />Connection by <br />Address <br />Phone <br />Legal Description: <br />Lot Tni..q 1 thr i h 11 - njo k 12 - <br />Block — <br />Plat r_l�asIst Alan <br />Unplatted Description: — <br />Type of Permit — NEW « �yy <br />Remarks - <br />IMPORTANT! <br />CALL 1-800-424-5555 48-IIOURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Utility Account No. <br />Permit Fee $ <br />Connection Charge <br />Trunk <br />Lateral <br />Total Connection Charge <br />Utility Development Fee <br />Water <br />Sewer <br />Total Development Fee <br />Sewer Bond District <br />Abutting Lot Line <br />N, S, E, W .— <br />Approved By <br />Issued By T n^ru <br />Customer Signature _ <br />Inspection By <br />Date Inspected Z <br />110-y"4191111W <br />NO. 28301 <br />ft. <br />0 <br />1 <br />0 <br />