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� O <br /> � �i{-1F\`i I N�. __. . _— —_ _ _"_ <br /> ��� I everett <br /> .a�x � _ .. .. - <br /> r x� I - � = � . . ._ .,� <br /> � �� � City of Everett r _ Td <br />� H 7.� I � � ' .. � <br /> y �r �I Sevver �pplicati.on �nd P�rmit TO POST'��c 3_�� <br />' � o� I - - = � <br /> H t1 � _. �.. ,L _ �... : -.- ,. <br /> H �o I NO. 2g7�� DdTE +..�s� �'z. ,���.� I — <br />� �� � <br />� z H[g ' Ser.ice Address 8II:—A7 nt rt, Uliliry Account No. — <br /> 9 y tjJ I <br /> ti <br /> L Hy <br /> �I Billing Address <br />' � b�' , Ciry, State, Zip � g�---- Permit Fee $ <br /> � t�r I �onnection Charge <br /> i Gwner <br /> H O� • y• c� <br /> Connection by �r:nn� `��'�""`' tx co.v Trunk <br /> Address Lateral $ <br /> Total Connection Charge $ -9- <br /> Phone ����- Utiliry Development Fee <br /> ��� Legal Description: Water $ 224 oD <br /> �� I <br /> Lot 1 Sewer $—524:t1C il <br /> ��. Total Development Fee $@l�_nn <br /> �� Blor.k <br /> Plat ' <br /> r,� Unplatted Descriptlon: Sewer Bond Disirict — -- <br /> _ Abutting Lot Line <br /> ��'�� N, S, E�W ft. � <br /> Type of Permit tarvl corr�ec2totL Approved By <br /> �� � Remarks Issued By_� ' <br /> Customer Signatore <br /> '�� IMPORTANT! I <br /> � <br /> CALL 1-800-424-5555 48-HOURS <br /> PRIOR TO DII�GING �� <br /> i Inspection 8y _ ��' '�' '� " - , <br /> CALL 259•8810 FOR INSFECTION � �_a z <br /> Date Inspecter! <br /> SEE SKETCH ATTACHED N�. 2�7�I� <br /> I <br /> Ir�S;'FCTIO?! I <br /> I . . _......__ _ _n i 7 � ,. — <br /> _—_--_— . .. _ - . _ . .. --�^-� . � ' <br /> � � A� a.t <br /> M. �� :'�i�r 'Y! �� ( � � ..� .F_ /t�%i:': . e ..�i'`�f '�5 `` � ���� t� ,� ��d"fi.i'1,t��f <br />