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CH.,RT NO. <br /> everett <br /> t� �S�.�n� <br /> s - � - �� <br /> City of Everett <br /> Sewer Application and Permit <br /> NO. 2$lOH DATE <br /> Service Address Utiiity Account No. <br /> U7/"dli5y :.o4H1'i1000R1154P.1^. GfKY <br /> Biliinp Address , <br /> City, State,Zip iws�tt�tql 9f3p� Permit Fee $ ����1�� _ <br /> Owner Connection Charge �Fl�cP e.10.00 <br /> Connection by Trunk S <br /> Address !ateral $ <br /> _ Total Connection Cherge $ <br /> Phone • Utiliry Development Fee <br /> Legai Description: Water S <br /> �,p� Sewer S <br /> g� Total Development Fee S <br /> Plat <br /> ON <br /> Unplatted Description: � Sewer Bond Disirict <br /> � Abutting Lot Line <br /> � <br /> �( c� N�S� E�W — ft. <br /> l� <br /> Type of Permit � �.. _�_ Appraved By <br /> Remarks Issued By J .po�w;; <br /> r <br /> Customer Signature � - '='��" <br /> � <br /> IMPORTANTI <br /> CALL 1-8Q0-424-5555 48-HOURS <br /> PRIOR TO DIGGING ����_ <br /> CALL 259-8810 FOR INSIPECTION Inspection ey <br /> Date Inspected �- �� - 5/ <br /> SEE SKETCH ATTACHED No. LS1O8 <br /> IWSPECTION ' <br />