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I <br /> ' everett CHART NO. <br /> � <br /> � <br /> �"� � : TO PC)SFING lo-z5-;, _ <br /> 9�3 <br /> a y� City of Everett - _ - � ����IGC,w f i�� ���,,K;f� � <br /> � �� � Sewer A lication �nd_ Perrnit � 'I <br /> o xo I pp __ _ , _ ; TO P�JSTING �� .� � <br /> '� �H _ _ _ � - i <br /> �io� i NO. 2H164 -DATE �,rc�� .� i' �1 � ---- I <br /> HG <br /> H �g Service Address yOil -�tn ur Gi: Utility Account No. — <br /> zH� BillingAddress —U' U� ?: 34th Se <br /> � HH I Cit , State,Zi ��:=t��� c.-: o�itn� �O•�� � <br /> Y P Permit Fee S I � <br /> gb y � Owner Cconercu Co;�ner.tion Charge <br /> � �t � Cannection by ?d�� � <br /> Trunk $ <br /> 2 H Cm/� <br /> '3 �y Address Lateral $ <br /> I <br /> � - Total Connection Charge $ -�- <br /> � Phone _ 547-6213 Utility Development Fee <br /> I Legal Description: Water $ 179.OU � <br /> �� <br /> � � Lot 1 Sewer y 471.90 <br /> Block - TotalDevelopmentFee $ �5�•��� <br /> 'a+ r <br /> �+ PIBI f.nthrin TV <br /> Unplatted Description: Sewer Bond District <br /> �..� __ Abutting Lot Line <br /> N, S, E, W h, <br /> —.. ..� Type of Permit ���u connection Approved By <br /> Remarks Issued By :::�rc;ar.:c t•!cLeod <br /> � _/ : '/ I ( <br /> """ � Customer Signature �-' � � <br /> IMPORTANT! <br /> � � <br /> CALL 1-800-424-5555 48-HOURS <br /> PR:OR TO DIGGING - <br /> � ��/���-'�� .�� <br /> CALL 259-8810 FOfl INSPECTION Inspection ey l �2�... � � ` . _ <br /> Date Inspected 3 �� � <br /> � <br /> SEESKETCHA77ACHED Np, 2$��� <br /> � Ih1Sf'�CTICiJ <br />