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i <br /> � � 1 <br /> H <br /> � y� .,. ; <br /> K � � CHART NO. ' <br /> � x� everett � <br /> H ::i <br /> y �. <br /> O ��4 P� C pC � <br /> �i t�s7 G.+ L i; � F�i i i C'� :� �' i� J t�I <br /> c�� o City of Everett ; _ � � � � " � � �4 T� PbSTI I�C. �-�-`�-43 I <br /> �' � :» � "' � .� w c � <br /> 'Yy � .�. µ� <br /> . M I ,.., ; . <br /> � yy Si:wer Applicatio�,.�nd ��n� �� _. <br /> � .. F CJ �] i � <br /> �„� r: r� ;,� — :¢ 'ad' ,:� � � � �:: <br /> �]d� ,G � GKi "rJ'_ i� iG � 0. � ]`3' � tj-`, _ W <br /> �y� NO. 2H�°7 DATE � ,� a, — v <br /> i <br /> HOCn <br /> Service Address — Utility Account No. --- <br /> Billing Address , <br /> Ciry, State, Zip *^������ v� qg2p� Permit Fee $ z� 00 — <br /> Ownur Q *� +� x n a nld Connection Charge <br /> Connection by Trunk $ <br /> Address Laterai $ <br /> Total Connection Charge $ — <br /> Phone �5� acnn Utility Development Fee <br /> 1 ; Legal Description: Water $ -37° ^" <br /> � Sewef $ 671 00 <br /> Lot � f ch r a� * fi 91 <br /> ' t Block Total Development Fee $ �t^ ^.�.T— <br /> '�' Plat . � <br /> �1 Unplaried Description: Sewer Bond District --- — ' <br /> �� Abutting Lot Line <br /> ' N,S, E,W — �' <br /> ' Type ot Permit avc ^^^�'^�*nra _ Aoproved By - <br /> � 1 Remarks Issued By MH -- ' <br /> �' Customer Signature <br /> ' IMPORTANT! <br /> ' CALL 1-500-424 " � 48-HOURS <br /> — - PRIOR TO UIGGING � f <br /> Inspection By✓`�`�`"`-" <br /> CALL 259-8810 FOR INSPECTION �_ �.3 <br /> Date Inspected <br /> SEESKETCH ATTACHED NO. Z8797 ' <br /> INSPECTION _. <br /> . <br />