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�r� <br />� <br />p�x <br />�Ht~n <br />y�r�i <br />�H� <br />"�Q N ';I <br />VJ Nr <br />Cx�] O l+1 <br />OHd <br />��g <br />� Y (� <br />zH�H <br />HH <br />� <br />c�Cy <br />��M <br />H O l�i� <br />� <br />i <br />LJ <br />� <br />I � <br />everett <br />e <br />City of Everett <br />Sewer Application and Permit <br />NO.Z$7n5 DATE +� n..�+i in inni <br />Service Address 1010 ^,emnle nrive Utility Account No. <br />Billing Address ��� R r i ea <br />Ciry, State, Zip s,w tt_�.a 7ozn1 Permit Fee $ <br />Owner „ „ Connection Char�e <br />Connection by <br />Address �TiS—}@gt{ ^' ��— <br />�_�#—�?+ 9838� -- <br />Phane <br />Legal Description: <br />L0I _. •, ..,.._u r �,. ei3ee�.�7� <br />Block � . <br />Plal +ti ar¢ �ra�*i <br />Unplatted Description: <br />Type ol Permit <br />Remarks rev o �Tc7�[a'-[tsib�it�— <br />., - � <br />IMPORTANT! <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8510 �OR INSPECTIaN <br />SEE SKETCH ATTACHED <br />Trunk <br />Lateral <br />CHART NO. <br />TO POSTING ��-'&�s� <br />� <br />Total Conneclion Charge $ <br />Utility Develupment Fee <br />Water <br />Sewer <br />$ <br />$ <br />TotalDevelopmentFee'� ���$' � • '�� "'"''��`• ��� — <br />;� �� �� �.rc.;..:. <br />Lt li�� 1'.S, .'_{I <br />Sewer Bond District , , _,,,,,, <br />idi!I '.�,O.ip' <br />Abutting Lot Line �.� �� i.�; i�;,';', <br />N S E W �: '.i'CII ' �„9n ft. <br />I•I'!If,' 1:'p.�;il <br />Approved By i:Critl`ri^iL`� <br />itl�t:R * �.It.�;n <br />Issued By �9a=1g1 '' ! V? ° <br />Cuslomer Signature �: ;: _ .. - <br />:i,�n:: ,,,,. <br />n:,u,; ,.u.�v <br />�ti���; ,._. �.., <br />Inspection By ������� — <br />Date Inspected �� � F � <br />ws�ECTiei i <br />No. 28205 <br />