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� -- -,----- - - — — - <br /> .... . .:-c-...._ ,..__ .. . t--- - —- —— — ----— -- --- --- ----- --�---— -- -- <br /> � � . - � � . � � , - . . . . . , . . �� , .. . . , . . � . . � .j <br /> ` CHART NO. � <br /> � <br /> � <br /> i <br /> .�-�����' TO P0571NG_��-� <br /> ; <br /> , <br /> ' �eu��er �!►pplica#ic�n �r�d Perrmit i <br /> � 1 I l �l`i <br /> ?� � � " DATE � 7/19/�a � <br /> �ervice Address II03 40eh Pl U;ility Account No. <br /> 32kU Eaa.:lake Ave E C2U0 <br /> Billing tiddress � <br /> n <br /> City, State,Zip _ Seattln WA 98102 _ permit Fee $ 70.00 � i <br /> Owner Du11y tio�es Connection Charge I <br /> Cunnection by Trunk $ , <br /> Address Lateral $ <br /> Total Connection Charge � `�"' � <br /> I <br /> Phone Ulility Development Fee � <br /> Legai Gescription: Water � 179.09 j <br /> I <br /> Lcl 30 Sewer g 471.00 _ <br /> Block 7otai Development Fee $ 650.00 II <br /> PIc1t Silvarhnsrk � <br /> Unolatted Description: Sewer Bend District <br /> Abutting Lot Line <br /> i <br /> N, S, E, W ___ ft. i <br /> Type of Permit _ fleu connection Approved By _ <br /> Remarks --_--- Iss�ed �3y — �b , <br /> Customer Signature ' � �� �_ � �--�- r i •,.� �7 , <br /> , <br /> IMPORTANT! :;' '-: �; �"; r G �' ��. � � � r. <br /> h <br /> m _.� m � ir"� � .�+'�i �i �in� -a . <br /> f= � ;: r� ?o n <br /> � , a � x `� .... ,:5 <br /> CAL� 1-800-424-5555 48-HO�1RS,� •` <br /> PRIOR TO DIGGING;, �„ „ �: ,,, � :• I <br /> �� L' ^: J <br /> PJ C G tA <br /> .- +� n.i <br /> CALL 259-8810 FOR INSPEE�1(�N g �y� �n�pectiorr�By �s�P �y+��h I <br /> ,-, <br /> Date Ins�ted �o-/-3'3 i <br /> „_ <br /> �,; i <br /> SEE SKETCH ATTA.r,HED �� � <br /> t INSPECTION ? �':�'� z g 3�� <br /> � ;Y <br />