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g <br /> CHART NO. <br /> everett i, <br /> �i <br /> �n� � _ _ _ _ TO POSTIhG I <br /> m�x - - _ �� I <br /> �H�, City ef Everett _ - - _ <br /> � �o i Sewer App�icatian a�nd Rermit _ , <br /> _. _ _ I <br /> 'i1 H"i1 �_ _ - ' _ ' _ _ _ _: '_ <br /> � o� � rio. 2 813 0 �are �. _ _ = _ _. - ., ._ = :+ =- , <br /> HC I <br /> � �g I Service Address — Utiliry Account No. <br /> c�� o <br /> z H Billing Address <br /> �" H� City, Stzte, Zip ' ' Permit Fee $ - <br /> gN" � <br /> o t7 rn Owner Connection Charge <br /> � �� Cr,nnection by __ Trunk � � <br /> `3 �v' Address Lateral $ <br /> i � � <br /> � _ Total Connection Cha�ge � I <br /> � Phone Utiliry Developmenl Fee � <br /> � <br /> I Legal Description: Wa�e� $ — I <br /> ���„ _. i <br /> �.,� Lol — Se'.er $ i <br /> IBlock — -- Total Development Fee $ <br /> � � <br /> �� Plal . <br />, Unplatted Description: — Sewer Bond Dislrict <br />, �� � <br /> �„ 1 = Abutting Lot Line I <br /> N, S, E. W h. <br /> !`� Type of Permit �...���e��, __ Approved By <br /> Remarks Issued By • <br /> �#� __._ _ Customer Signature <br /> � '' IMPORTANT! <br /> . , <br /> CALL 1-300-424-5555 46-H011RS <br /> PRIOR 70 DIGGING � ' � <br /> • Inspection By �� ", I <br /> CALL 259-8810 FOR INSPECTION � / � <br /> Date Inspcc[�d "� 5 ��� i <br /> SEE SKETCH ATTACHED No. 2P l 3 o I <br /> ir`si���crior� <br />