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<br /> I
<br /> ICHART NO. II
<br /> Ieverett i
<br /> ��� e �
<br /> 9H
<br /> Ta Pos�n��c s�= I
<br /> ay y Gity of Everett i
<br /> H �3'
<br /> ~ �~ ��wer Application and Perrr��t �
<br /> �C H� i
<br /> � Fxi� I
<br /> y �r � DATE �/2/92
<br /> x No. 28742 —
<br /> � y� I , �'.� . o;�r.:., . ,
<br /> � u;. �_.,.,n,
<br /> � �g i Service Address BSRT 5Q i i 5zr nv t' _ Utility Accaunt Na.
<br /> ,��Rit3,�.;,,�,
<br /> Hy � Billin Address - . ' ::� '=0ft-- ';`[:'�; �':'� 'Y
<br /> xy 9 iiBG '7li.iir;
<br /> E" z City, State,Zip _�.j,,g--ggg��---- Permit Fee � +�'�'�a ' �4;'^_P—
<br /> H�J �? `.li�(�11 'x-i .'Jlr
<br /> N
<br /> H Owner S����� �+� — Connection Charge �,; i��,i�, ��j;_,',;,
<br /> o cC7 m
<br /> � trl� 7� /a'i��i s-� Trunk '�r iP�t;l:s ; i
<br /> Connectionby �;,it[,; +.:,:_,.�n:
<br /> x H Cn 'p:il�(g"8•,''f� _
<br /> 'ao�' Address — Lateral ,r!�1'i.f' !"ti.+,;�
<br /> Total Connsction Charge��1$'i—'Q�ti�
<br />. — .;�'liti 1„.:,._4� I
<br /> ; Phone — Ulility Development Fee i•r, � ;, I
<br /> ' I t i.il i 7�., I
<br /> � � Legal Description: Water „E,a$ +� ^^
<br /> �� ���, i 1 ��11 � .--il �
<br /> C� Lot 21 _ Sewer �„i ,�,�- �
<br /> Block Total Development Fee " ''�� " �� ^�`
<br /> t;l:l Lt, —',....�,il"�+�------
<br /> i�'�'� Plat ^ - - ;<���t�"�';.�.
<br /> __= iii ghlands ,_.f:IvM:C , .D.�m
<br /> Unplatted Description: — Sewer Bond District �'"' "` ' ��% —
<br />, r��f-�;. . . ..�.';ri
<br />' '��, _ Abutting Lot Line
<br /> ��C
<br /> I N, S, E, W ft.
<br /> �'_� Type ot Permi� t7r.� connection Approved By
<br /> Remarks Issued By GB
<br /> ��
<br />' =- _ Customer Signature I
<br />, I IMPORTANT! i
<br /> '+'s' � CALL 1-800-424-5555 48-HOURS
<br /> PRIOR TO DIGGING
<br /> Inspection8y �":�� ,:r`' •.� �
<br /> ' CALL 259•8810 FOR INSPE�TION I
<br /> Date Inspected — �� �`� �`
<br /> �
<br /> �
<br /> SEE SKETCH ATl'�1�,.HED No. 2$7�l I
<br /> I
<br /> IIiVSP�CTION
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