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0 <br />A�� <br />9HC~i� <br />H�� <br />fC C�. <br />��� <br />� <br />x <br />��ty <br />��g <br />4H � C] <br />Z9y <br />r�H <br />g�� <br />�H� <br />HOCn <br />�w� <br />� e <br />everett <br />� .� <br />City of Everett '�, � � �� <br />'�... �^' � M <br />Sewer Applic�tion and P�C�i�, LL� <br />r' � ;.� " = <br />NO. Z H.�] �i S DATE n,r.,.tm � i o�, qol _ <br />Service Address 415 1uAi�on St <br />Billing Addr+ss �1-8^� ?��� <br />City, State, Zip gy��SE,�:n 98283 - <br />Owner _ <br />Connection by _ <br />Address <br />Phone _� <br />Legai Description: <br />Lut __ <br />Block <br />Plat <br />Unplatted Description: <br />Type of Permit ���, _ <br />Remarks <br />IMPI�RTANT! <br />CALL'E-800-424-5555 48-NOURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Utiliry nccount No. <br />Permit Fee $ <br />Connection Charge <br />Trunk <br />CHART NO. <br />TO POSTING_�el�,, /� <br />�, ���; <br />p G ,.J <br />�.p ;w .� r � .-* <br />� w �: <br />� <br />_;�u���, <br />�" :: � W <br />`�_ w� a <br />Lateral <br />Total Connection Charge <br />Utility Development Fee <br />Water <br />Sewer <br />Total Deve'�pment Fee <br />$ <br />$ <br />$ <br />$ 1T9.00 <br />g nn.on <br />$ 65D.00 <br />Sewer Bond Dislrict ;..Fr„gi�eA <br />Abufling Lot Line <br />N, S, E, W ft. <br />Approved By _ <br />Issued By �T s�kM+i i <br />Customer Signature <br />Inspection By ��ye%��^— <br />Date Inspected �' � `i t- <br />INSPECTION <br />No. 28545 <br />