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everett <br />�e8� <br />City of Everett = r <br />T <br />Sewer Application and Irmit <br />NO. 2841 S DATE Sent <br />CHART NO <br />la ?cs4, 0 <br />a/g/ <br />Service Address — 31,11 Wgt• re <br />Utility Account No. <br />Billing Address <br />— <br />City, State, Zip <br />Permit Fee $ _ <br />Owner <br />Connection Charge <br />; <br />Connection by <br />Trunk $ <br />Address <br />Lateral $ <br />Total Connection Charge $ <br />Utility Development Fee <br />Phone <br />Legal Description: <br />Water $ <br />Lot _ <br />Sewer $ <br />Total Development Fee $ <br />Block <br />Plat <br />Unplatted Description: <br />Type of Permit <br />Remarks <br />IMPORTANTI <br />CALL 1-800-424-5555 48-HOURS <br />PRIORI 0 DIGGING <br />CALL 259-8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Sewer Bond District <br />Abutting Lot Line <br />N, S, E, W —_ <br />Approved By <br />Issued By <br />Customer Signature <br />Inspection By .� <br />Date Inspected <br />INSPECTION <br />No. 28415 <br />ft. <br />