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CHART NO. - <br /> everett <br /> _ SL�.l� I�. ��CT7�iK/ <br /> = 9�v�r�� <br /> City of Everett - '� _ - _ - <br /> - -. - <br /> Sewer �4pp�ica�tion-:and��Permit <br /> NO. 27�9� . T 'DATE o�coe�c�, i oan <br /> Service Address —5531a► � • Utility Account No. — <br /> Billing AddreSs 528 n ' - ' <br /> Ciry, State, Zip ���� Permit Fee � ;g,gq <br /> Owner — Connection Charge <br /> Connection by Trunk $ �,�— <br /> Address Lateral $ <br /> Tolal Connection Charge $ �'/d �� <br /> Phone Utility Development Fee <br /> Legal Description: Water $ �c+ �; <br /> Lot Sewer $ 68a o0 <br /> Block Total Development Fee $ —3S9.�o <br /> Plat <br /> Unpiatted Description: Sewer Bond District �.�IYI <br /> Abutting Lot Line <br /> N, S, E, W gg• n• <br /> Type of Permit __� Approved By <br /> Remarks Issued By <br /> Customer Signature <br /> IMPORTANT! <br /> CALL 1-800-424-5555 48-HOURS <br /> PRIOR '(O DIGGING <br /> Inspection 8��`� <br /> CALL 259-8810 FOR INSPECTION <br /> Date Inspected � �r-y � <br /> SEE SKETCH ATTACHED NO• 279 y� <br /> INSPFCiION <br />