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�, <br /> �� � <br /> A� x <br /> �Hf~i� <br /> y��c CHART NO. ' <br /> K y �, everett �! <br /> �H � ;� <br /> � H e � <br /> � �� � <br /> � r City of Everett - ,: , �� [�Q�TING�` ' �c -q �- II <br /> c�• g - i' <br /> � � <br /> �y� Sewer Application and �,ermit � <br /> NH � .,� s <br /> 8�' = _ :' =` _ <br /> �..� c '� ' <br /> �����+ NO. ZH194 UATE ��:. •��ng� I� <br /> H v[rz1i 'i <br /> i3� �' Service Address 4421 Terrece ur Utility Account No. <br /> 19515 9'ift 1 ' •� � <br /> BillingAddress �.,-" "---�-T— <br /> Permit Fee $ �.5[� �I <br /> City,State,Zip � e„�, "� ^" il <br /> Owner .s� ��+ �� � � " � ConnectionCharge II <br /> Connection by — Trunk S I� <br /> Address -- Lateral $ ��,I <br /> i� <br /> _ . Total Connection Charge $ I' <br /> I Phone o� -+���; �����;,� UtiliryDevelopmentFee I <br /> ��� � Legal Description: Wa1ef $ �� <br /> 1 � Lot �> Sewer $ �I�, <br /> �� Total Development Fee $ <br /> �� Block <br /> Plat Yictorv Lei�htv AQd. '�'�� <br /> Unplatted Description: Sewer Bond District �' <br /> I �� <br /> Abutting Lot Line , <br /> NSEW ft. i <br /> i �+ <br /> Type of Permit � ff Approved By i <br /> ' � <br /> Remarks Issued By ; <br /> ��� Customer Signature <br /> IMPORTANT! � I <br /> ����1 �i������-. �— � <br /> CALL1-800-424-5555 48-HOURS ��°" �'��, , <br /> � PRIOR TO DIGGING �/y z <br /> Inspection By ; , <br /> CALL 259-8810 FOR INSPECTION I� <br /> Date Inspected I,I <br /> SEE SKETCH ATTACHED N0. �S 1 9�I II <br /> INSP6CT10�4 <br />