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i <br /> j <br /> HO � <br /> A � x ' <br /> t' xI� � �, <br /> H �'LH <br /> fC C] <br /> y � CHART NO. -- i <br /> �� H everett i <br /> CTl y � � `r/j/�Z I <br /> ��g �/ = ;.. s � � s ,_ � ;.�'0 P0�?iNG_� �- ,. i <br /> � � � City of Everett ` : � � ` , <br /> r z '� '' �' • '' I', � <br /> gyH �ewer Application anc� Perm�f ., ;�� � �" I, <br /> n ty v, . , _ =- <br /> � ' � <br /> s = '>r <br /> �� [��J n ys :_ � .� = .` =. :- ., — >c . _ I <br /> � <br /> yovi NO. �$3 :>7 DATE , _i r �s, �e�» <br /> Service Address �l – 46t1i St S�; Utility Account Na. 1 <br /> Billing Address 12414 4 ith Ave sr <br /> Ciry, State, Zip rWP rr un ���nt, Permit Fee $ in nn <br /> Owner � Connection Charge <br /> Connection by �–�� � > C�-�� °�– Trunk $ <br /> Address Late�al $ <br /> Total Connection Charge � '�' <br /> ��j Phone Utility Development Fee <br /> ��� I Legal Description: Water $ ��t. 00 <br /> ��, Lot I Sewer $ 589.00 <br /> � ' Block — Total Dovelopment Fee $ ¢�� ^D <br /> � <br /> �' Plat r « n....i. •.+a.. .,+.. . <br /> 0� Ur.platted Description: _ Sewer Bond District I (ret3red) <br /> � <br /> �' _ Abuttirg Lot Line <br /> '� N, S, E��'1 g, I <br /> � ' <br /> Type of Permit ldew connectior� �pproved By � <br /> �� t;it <br /> ' Remarks Issued By <br /> � <br /> Cuslomer Signature <br /> 4 IMPORTANT! <br /> II CALL 1-500-424-5555 4R-HOURS <br /> PRIOR TO DIGGING / <br /> Inspection ey ���`( °"'--- <br /> CALL 259-8810 FOR INSPECTION <br /> iDate Inspected � �� y i I <br /> I SEE SKETCH A'ITACHED NO. ZS38T II <br /> i <br /> � i��!�I'�� „ .._ i <br /> I <br /> _ !I <br />