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� � �CNART NO. =���=�'—� -`"-- <br /> p � � everett <br /> � H N � <br /> M � _ <br /> M <br /> K HH � <br /> y�p M '�9 <br /> N M <br /> � � � City of Everett <br /> � � � Sewer Application and Perrnit <br /> HF+ <br /> � o N wo. 2 8 0 9 5 DATE � � �� -- <br /> � e°ar <br /> � � y ServiceAddress ��,� ����'�'C� UtiliryAccounWa. <br /> Billing Address <br /> City,State,Zip Permit Fee $ — <br /> Owner Connection Charge <br /> Connection by l runk $ <br /> Address Lateral $ <br /> To�al Conneclion Charge $ _ — <br /> � . <br /> Phone Utility Development Fee <br /> I C� Legal Description: Water g — <br /> 1 Lot Sewer $ -- <br /> �� Block Total Development F,.e $ <br /> �� <br /> Plat <br /> Unpiatled Descrip�ion: Sewer Bond Di,trict -- <br /> � �"� Abulting Lo[Line <br /> N,S, E,VJ n' <br /> "�� Type of Permit � �1�/�/� J ' � Approved By <br /> Remarks � ���� /?��+i�✓ � X /UTrzr2 �ssued By�,��'l <br /> ���� ���� .��$�„v n /' 7'"Y Customer Signature_-- - <br /> �,��P. ��.v-e MA,,u i� •�! . <br /> � IMPORTQNT! S- n �- ,� <br /> I ��► CALL1-S00-424-5555 48-HOURS SS C F�� `� ,� � <br /> � � o i��.� �' a�s ,— <br /> PRIOR TO DIGGING .3�� /✓- f <br /> Inspection By�. -� <br /> CALL 259-8810 FOR INSPECTION 7/��/ �� <br /> Date���spected —T — <br /> SEE SKET�H ATTACHED No. ?8 0 9 5 <br /> GUSIGI.Sf_li G_ <br />