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i <br /> CHART NO. — - <br /> � ro I everett <br /> � � � I TO POSTING �i-s-�z <br /> ~ � �-1 � <br /> o � � City of Everett <br /> N t+ <br /> � � Sewe� �►pplication and Permit <br /> o � <br /> � � <br /> � . <br /> � y � NO. ��'7 p ? DATE c,-is �° . <br /> M I 7i.'l5i";: li:.�..�a-ci il(ii:ii�tiy:�l�,. , . <br /> W <br /> � d N Service address s>> GArh vi �c Utility Account No. <br /> 'sl(![IUUEI&' <br /> y Billing Address --21 '' lJ:�1F.P ::iCCi.Ot� <br /> O � I j �fi�;}';�i <br /> Ciry, State, Zlp —�z Permit Fee $ ,, �t F ;.;�i,.ri+ <br /> ConnectionCharge it':l,'� F.�::1"•.�'� <br /> Owner ;cu;i�::,;r„;t <br /> Connection by _ Trunk Bi{���$ �� 1' — <br /> PI BG icA.�h= <br /> Address <br /> Lateral rECtl$ ._:�. ' <br /> i; �;Irll t:,,��7 <br /> Total Connection Charge�;,,��� �,—,._; <br /> Utilit Develo mentFee �'� '� �}� '"'�1` <br /> Phone �se �61s Y p �',HFGsi �l't l:?,'''� <br /> �' ' ; Le�al Description: <br /> Water $ <br /> � �� Lot � �� F Sewer $ <br /> Total Development Fee $ °1 ^" — <br /> 81ock <br /> 1 I��� Plat 4 <br /> - � <br /> ' Unplatted Description: Sewer Bond District — <br /> ' Abulting Lot Line <br /> I �� N,S, E,W ft. <br /> '� Type of Permit Approved By <br /> � `��� � <br /> Remarks _ Issued By <br /> CustomerSignature—;�'� � <br /> � '__ , <br /> � �.�� IMPORTANT! <br /> I CALL 1-500-424-5555 48-HOURS <br /> ����( PRIOR TO DIGGING <br /> _ ..�y� <br /> Inspectian By �"" <br /> CALL 259-8810 FOR INSPECTION Date Inspected �"1� � � <br /> SEE SKETCH ATTACHED N�' 2$783 <br /> INSPECTION <br /> f <br />