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everett <br />City of Everett <br />Sewer Appl <br />� <br />=; <br />.� ;3 zrlt-Ci�: � <br />❑i r - ' <br />- :, - ; <br />�.v � ;w . -' —: <br />:.: .s, `' � .. <br />ication ar�d�erm�it ��_ . <br />�, <br />� :_ ��� `��� <br />u� -_—�¢J �� �i:r �.z _'� <br />NO. 2$ 2 6 7 DATE ���yy� <br />Service Address 8032 spokano Dr Utility Account No. <br />Billing Address ���� llfi** �c er. <br />City, State, Zip sw��tt nrn 9esoe Permit Fee $ <br />Owner �at x.s1, oonet Connection Charge <br />Connection by se� <br />Address <br />Phone _ 337-7153 <br />Legal Description: <br />Lot Z, sr ol-9D <br />Block <br />Plat <br />Unplatted Description: <br />Type of Permit �+ �nneetion <br />Remarks <br />IMPORTANT! <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />;,�E SKETCH ATTACHED <br />Trunk <br />Lateral <br />CHART NO <br />SeH�I- fa �or-��,� I-�-�a� <br />Total Connection Charge <br />Utility Development Fee <br />Water <br />Sewer <br />Total Development Fee <br />$ z7o.0o <br />$ 450.00 <br />$ 720.00 <br />$ 1�9_00 <br />g a�i.00 <br />$ 650_G� <br />Sewer Bond District Bona Ii <br />Abutting Lot Line <br />N, S, E, W ft. <br />Approved By <br />issued By *+��q•++�� N^T�^� <br />Customer Signature � <br />�_1����� <br />Inspection By <br />Datelnspected (I/!L�/ <br />irisar_cTioN <br />No. 28267 <br />