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p�x <br />>yv�i <br />��� <br />"�� H "C <br />VJ N�+ <br />� O R1 <br />H <br />��8 <br />� �� <br />i-+ H <br />g �� <br />��� <br />r <br />ta <br />HO� <br />� everett �� <br />I -_ <br />� 4 � <br />Y <br />r_; L� u � <br />City of Everett � � -' :- <br />- = w .,, <br />Sewer Applicatiori;�ai�Permit <br />I � . <br />r, � 5'L'�c,� �' <br />� NO. 2g57� DAT�' 1/13I92 <br />Service Address A219 Spoknne nr <br />Billing Address �35 4elegzaph Rd <br />Ciry, State, Zip _ 'ellinrham uA 58226 <br />Owner Rr P'n;7 S�u�h Pn.r nrn <br />Connection by <br />Address <br />Phane <br />Legal Description: <br />Lot <br />Block <br />Plat <br />Unplatted De�cription: <br />Type of Permit ca�off <br />Remarics �.,Y � �" �� n � <br />�. <br />IMPORTANT! <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Utility Account No. <br />CHART N0. <br />Permi; Fee S <br />Connection Charge <br />TO POSTING_l_/�-Q� <br />Trunk $ <br />Lateral $ <br />Tolal Connection Charge $ <br />Utiliry Developmenl Fee <br />Wa!ar $ <br />Sewer $ <br />Total Development Fee $ <br />Sewer Bond District <br />Abutting Lot Line <br />N,S,E,W _ <br />A,�proved By — <br />Issued By <br />.^•ustomer Signature <br />z.so <br />C3 <br />� <br />�� / / <br />% <br />Inspection B <br />�c <br />Date Inspected <br />INSPECTIUN <br />No.28570 <br />s <br />ft. <br />