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everett <br />City of Everett <br />CHART NO. <br />l o ��as-� ,� <br />l�/��9� <br />Sewer Application and Permit <br />NO. 2841.6 DATE Sent. 9. 1991 <br />ServiceAddress 2nn, s�„�.. <br />Billing Address Sane <br />City, State, 2ip L`verete G�1 98201 <br />�yy�gf .Tn�•oa .ln]j,� ' <br />Connection by � rtaa� <br />Address YnH z612 <br />:� <br />' — -- <br />Legal Description: <br />Lot <br />Block <br />Plat — <br />Unplatted Description: <br />Type of Permit Repair /l�I�P/a-f'��.; <br />Remarks <br />IMPORTANT! <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-6810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Utility Account No. <br />Permit Fee $ <br />Connection Charge <br />Trunk <br />Lateral <br />Total Connection Charge <br />Utility Oevelopment Fee <br />$ <br />$ <br />$ <br />LU.UO <br />Water $ <br />SeWef th':�fN$^i 11:'Uiirf �bA1��HC'�I4 i i i t. <br />Total Development Fee �`�-4a 'Ftv in <br />S��J�� S�Q.(Yl <br />i'il`Jr !.t0.f41 <br />Sewer Bond District <br />Abutting Lot Line <br />N, S, E, W _ <br />Approved By _ <br />Issued By <br />Customer Signature <br />on <br />InspeclionBy •�vL��� <br />Date Inspected �—�G �� <br />INSP�CTIO^. <br />No.284]_6 <br />ft. <br />