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CHART NO. <br /> everett f <br /> Se nf 7r. po�rl�,)tio� <br /> � 7-2�-91 <br /> City of Everett <br /> Sewer Application and Permit <br /> N0. 28345 DATE 7-//-�/ <br /> Service Atldress ��� Utility Account No. <br /> Bflling address � <br /> Cily,Stete, Zip � �-��%� �/� 'l��"� Permit Fee $ /lJ � <br /> � <br /> Owner � Connection Charge <br /> f�7/1(�91 4:29!'M OOlk1N7838 i tkt <br /> Connection by .c]/l?/L� Trunk S; -- — <br /> Address — Lateral �a�S <br /> SE1�F. � . <br /> Total Connection Charg�s� {i�`�� <br /> Phone Utility Development Fee <br /> Legal Descxiption: Water $ <br /> lot Sewer $ <br /> Bbdc Total Development Fee $ <br /> Plat <br /> Unplatted Description: _ Sewer Boud Disirict <br /> Abutting Lot Line <br /> N�g� E�yy ft. <br /> Type of Permit � Approved By <br /> Remarks Issued By <br /> Customer Signature <br /> IMPORTANTI <br /> CALL 1-800-424-5555 48-HOURS <br /> PRIOR TO DIGGING �� <br /> Inspection By � <br /> CALL 259-8810 FOR INSPECTION <br /> Date Inspected �-�` - �� <br /> ;EE SKEYCH ATTACHEG r,o. 28345 <br /> INSPECTIO�d <br />