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: <br /> � � ro <br /> p � CHART NO. <br /> � � y everett <br /> � x <br /> ' �' <br /> Ky � a �� �; � <br /> �tl N �C � L(.�� �� <br /> � N " S• o _ <br /> x <br /> o � City of Everett <br /> � � � Sewer Application and F'ermit <br /> .. <br /> �. y ' <br /> N H <br /> N <br /> � �°c� � No. 2 8 0 9 7 DATE �' � � � ` <br /> � � y Service Address 2 � � � � � � S� Utility Account No. <br /> Billing Address <br /> Ciry, State, Zip Permit Fee $ --- - - <br /> Owner Connection Charge <br />' Connactionby �L�`I U � t�'��Y�'-Z'�-- Trunk $ — <br /> Address _ Lateral $ <br />� Total Conr.ection Charge $ <br />�� ��'�\" Phone Utility Development Fee <br /> I �� <br /> I Legal Description: Water $ <br /> I �� Lot Sewer $ <br /> i I � Block Tolal Deuelopment Fee $ <br /> Plat <br /> I ' �� Unplatted Description: Sewer Bond Uistrict <br /> Abutting Lot Line <br /> �`'� N,S, E,W ft. <br /> i �� / / <br /> ' Typ?of Permit �'n��'r I ��T"� ^ ` A;.proved By <br /> '' (`�+ /�i � � i i1n� i � u.' �'�� � Issued By �o. , rv� . i l�,. -— <br /> �� . <br /> Remarks ' <br /> �?�/L �� ' S . �. ' 1^ ./ c� .-� ^�a Customer Signa[ure <br /> �/)� �.�., ! G ' J <br /> �� � IM'�ORTANT! -� , �( <br /> \ t� � /, <br /> CALL 1-800-424-5555 48-HOURS � <br /> PRIOR"f0 DIGGING - j�', . <br /> InspectionBy';� /,�'�� �/ �, ����� <br /> CALL 259-8810 FOR INSPECTION X�� �� /c� � <br /> Dale Inspected r <br /> SEE SKETCH ATTACHED No. 2 8 0 9 7 <br /> CUSTOMER COPY I <br /> � <br />