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CHP.iiT NO. I <br /> ieverett <br /> � _ r� nn�Tll�� 7� <br /> _ , � ,- - _ - _ - <br /> City oi Everett - � _ � - :. <br /> ha . J. <br /> ��M Sewer Application �nd Pe�mit , � , _ �', <br /> _ � r, � <br /> - � t; � r_ <br /> _ �.. � <br /> y�� I NO. �RS�`� DATE s /71"?_ - . i <br /> H �7 <br /> �H� 4215 7erracc Dr ��i�i�y Account No. <br /> �n H Service Address <br /> �� � Billing Address TO Eox ?26G <br /> � ~ � Evere[[ NA ?8206 Z^•OC <br /> H�g City,State,Zip Permit Fee $ <br /> H� � Owner t.t1r • ^�-^�• Connection Charge <br /> zy� <br /> '�" �„�y Connection by Trunk $ <br /> gd y Address Lateral $ <br /> [� t+ i Tolal Connection Charge $ <br /> t�1 <br /> ��' Phone Utility Development Fee <br /> � Legal Descript�on: <br /> Water $ 179.(10 <br /> Lot 2 5 3 Sewer $ 4�1 no I� <br /> � � <br /> � —� I Biock l.e Total Development Fee $ 1.S^ ^^ i <br /> ` Plat <br /> Unplatled Descrip[ion: Sewer Bond Distric[ <br /> i �� Abutting Lot Line <br /> N,S, E,W n � <br /> ��� i Type of Permit :i�v connectlor Approved By Cj <br /> Remarks Issued By <br /> '_1- Customer Signature <br /> I IMPQRTANT! <br /> �� CALL 1-8tl0-424-5555 48-HOURS I <br /> PRIOR TO DIGGING y. / <br /> Inspection By �""�`'f <br /> CALL 259-8810 FOR INSPECTION I <br /> Date Inspected 5 '��- s'� I <br /> � <br /> ISEE SKETCH ATTACHED No. 2a 599 <br /> I <br /> � IfdSP6CTIOfJ <br />