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CHART NO. <br /> everett ! <br /> ��� � <br /> m�x � TO POSTING__ << �9 a� <br /> a y y City of Everett <br /> 3 �" S�,nrer Application and Permit i <br /> � H� <br /> � H"��J � <br /> (n H <br /> � o� NO. Z$� �q DATE — _-- <br /> Hl7 <br /> �/� �� Service Address — Utiliry Account No. -- I <br /> y�Y C] <br /> x H� Billing Address — <br /> H <br /> r..�y City, S�a!e, Zip Permit Fee � <br /> $ �n <br /> �❑y N Owner — Connection Charge <br /> � y y I Connection by Trunk $ I <br /> y �y Address Lateral y . <br /> -. Total Connection Charge $ <br /> � <br /> iPhone Ulility Deveiopment Fee <br /> I Legal Description: Water $ <br /> a...r <br /> �1 I Lot L �f 3 Sewer $ _ <br /> Block Total Development Fee $ _ <br /> �... <br /> �� Plat . _ <br /> Unplatted Description: Sewer Bond District <br /> "`d- Abutting Lot Line <br /> �.,, ,,,,' — N�S, [, W ft. <br /> "`� Type of Permit ' Approved By <br /> Remarks Issued By <br /> � ! I Customer SignaWre <br /> � (� I IMPORTANT! <br /> CALL 1-800-424-5555 48-HOURS <br /> , PRIOR TO DIGGING / <br /> �C�j� <br /> CALL 259-8810 FOR INSPECTION Inspection ey� �/%'��' , -�"i�� <br /> � Date Inspected �� � ���i <br /> SEE SKETCH ATTACHED No. 28139 I <br /> ws��r::cru��; <br /> ; <br />