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. <br /> everett CHART NO. <br /> i � , TO POSTING 4 9 9 z � <br /> � � ,� I City of Everett - _ - - - = � �� I <br /> H � ; <br /> � �N � Sewer Applicatian and` Permit � � w � � <br /> � ` w � r' = � <br /> oxo N0. 2SS�� DATE ` y � � L _ I <br /> "tlr-� 'i1 ; — �a�--�-��,� 1�9' � . <br /> NH <br /> '� x � I Service Address ��a��v;��, tiyh <br /> [� p ; Utility Account No. <br /> � H d i Billing Address ��.T,�,g g��,_ <br /> �� g ��� n I Clty, State,ZIP �LrcTm ��. oo nr <br /> Permit Fee $ , <br /> z �"� � Owner �tvcacrr rncr�t .�Tccmr• I <br /> g r y Connection Charge <br /> � Connec�ion by _ I <br /> ��y I Trunk $ <br /> � Address <br /> � � � � Lateral � <br /> S— <br /> H o vi i Total Connection Charge $ <br /> , Phone <br /> , � Utility Development Fee <br /> I Legal Description: I <br /> � Water $ j <br /> i i Lot 76�r 6} <br /> `�� � Block Sewer $-2eF5 7? � <br /> '� ITotal Development Fee $_ „Q� 1 p <br /> Plat i <br /> I I <br /> Unplatted Description: <br /> I �� I Sewer Bond District _ � <br /> I i <br /> ; Abutting Lot Line i <br /> � ! <br /> � t 1 � — N,g� E,W I <br /> '�'� i Type of Permit _NFw r���FrTi�y A roved B , 't I <br /> n / , PP Y <br /> Remarks c.tlw . rf�-f/ �,/ ( "�D�i� � •� I <br /> I�� I Issued By �iucncc <br /> �.��� . So.. ..o n �,.._ . / / �/, , <br /> _�l <br /> ' i �,�,�.� --1-�Y�'— "�-7�-- Customer Signature ! ' <br /> ,tJ. . ., .� � -- ! <br /> i IMPORTANTI 5 ' �o�a @ /� u.'/� ;�9 i <br /> I <br /> � �� � `�� @ i''i�9.�v. <br /> I CALL 7-800•424-5555 48-HOURS <br /> � PRIOR TO DIGGING �Z� � S. o{' nvi-{ <br /> j <br /> i i <br /> � CALL 259-8810 FOR INSPECTION Inspection By <br /> i Date Inspec;ed J -�1 9 9�. � <br /> � SEE SKETCH ATTACHED <br /> i No. 28579 � <br /> ' ir:s�rc,i��:� <br />