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��`:. <br /> B <br /> a _ <br /> S ' <br /> � � <br /> CHAHT NO. — - , <br /> everet�t <br /> I <br /> 1 �- �f� �n$rlPJG s�a�-9� � <br /> yx t'�`�{1 = ---�_ <br /> tTl th y c?: <br /> �� �� n -' � :� - - <br /> y~ l':1ty of Everett � <br /> � �c�i - , �- - <br /> y;� S�w�r Ap�l��cai#ion�r�d:�Permit <br /> � I-'�?.' I i^ � C:� P.: J 'i a' 4 1 � ^ _ <br /> � z� i aJO. �I.�7�J 6� - :DATE�_�roTo� – I-- <br /> �o � i <br /> H �g Service Address �831 25th Ave N Utility Account No. -- I <br /> z H� Billing Address � ���^.—���'1-$d 4100 I <br /> y '�0 OC� <br /> i..i y City,Slate, 7_ip —a^aa=o:•a�'!A °p"^�w:--- Permit Fee � <br /> gd� Uwner ��-�----- Connection Charge I <br /> [� �� Connection by — Trunk � -- � <br /> `3 ��' Address _ - - - Lateral � I <br /> _ Total Connection Charge $ y,88 — � <br />' Phone _ Utility Development Fee I <br /> '�` " I Legal Description: Water � _ ��G.00 _ <br />; t�� i Lo[ - :' .e: $ — I <br /> � 9�L 00 I <br /> iBlock — — Total Development�ee $ i <br />, �� — <br /> Plat n ••a •.�a�� +Sigl�lawdc-- <br /> � <br /> Unplatte� Descripticn: Sewer 9ond District -- <br /> ��'� _ _ Abutting Lot Line <br /> ' __ N, S, E, W — ft. <br /> � <br /> �.,�� � I Type of Permit __�„��eeHoil__---- tiPProved By — I <br /> Remarks _ Issued By « <br /> ��' � _ _ Customer Signature <br /> IMPORTAiJT! I <br /> I�j�� <br /> CALL 1-800-424-55°5 48-HOU'rZS <br /> PRIOR TC DIGGING / / <br /> - !ospection By�S i�-�r ('"'. `�_ — — <br /> CAI_�.. 259-8810 FOR IMSPECTION � � ' �� 3 <br /> Dale nspected <br /> I SEE SKETCH ATTACNED r�o. 2�7�� <br /> I <br /> ��as,":_��i�c�,, �� <br /> ; <br /> I <br /> __ . � . � <br />