Laserfiche WebLink
��ro <br />b � � <br />Cyy N <br />M � � <br />�C 17 <br />A <br />� N H <br />� $ '�" <br />n0°� <br />M � <br />y' N <br />[ y <br />N <br />N <br />O N <br />�ro � <br />N <br />V <br />I �� <br />` <br />� <br />everett <br />� t <br />� <br />City of Everett : _ _ <br />Sewer Application ;�nd Perrnit <br />NO. QHZQS� �DATE� -. , ,T ,____'�_,?�9i <br />Service Address 6710 hutmore nve <br />Billing Address '°Of — <br />City, State, Zip �=rct�4n--'•'-�'-'^' <br />Ovtnerreer,,;�t�n�z�� ,.� -` Ta�---- <br />Connection by <br />Address <br />Utility Account No. <br />II CHART NO. -- <br />T� �11�T1+lG `+L� y Z <br />Permit Fee $ 3P "'� — <br />Conneciion Charge <br />Trunk $ — �--- <br />Lateral $ -- <br />Total Cc�nec"�n Charge $ ��� ^^ <br />Phone — Utiliry Deveioprt;e� �t Fee <br />--�d8-3839-�--- <br />Legal Description: Water $ �;9;ee-- <br />Sewer $ d" "" <br />Lot --- ---- -- <br />Block - — Total Development Fee $ , <br />Plat -' <br />UnplarieC Description: �- _« , , 9� Serrer i?nnd Dislricl <br />Abulrng Lol Line <br />-- — N� S� E� �`1 _ ft. <br />Type of I'ermit ,s;Q,,,_.�,o Approved By <br />Remarks Issued By r�e mt u r9oa — <br />__ Customer Signature <br />IMPORTANTI <br />CALL 1-800-424-5555 48-HnURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Inspection By ^V "" _— ` <br />Dato Inspected _ �° �� ' T/ _ <br />INSP�.CTION <br />No.2$20$ <br />