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everett <br />City of Everett E <br />s ` ` <br />Sewer Ap - icaliod- a duPermit <br />xTL3G] <br />\. yv n.,��ti r <br />NO. A �`'� 1 DATE M �+.�. <br />Service Address <br />Billing Address — 14 PiWireo SpaidVWY <br />City, State, Zip , ggg-3? — <br />Owner <br />Connection by Coyu _ n i S <br />Address <br />Phone 742-654d <br />Legal Description: <br />Lot <br />Block <br />Plat <br />Unplatted Description: <br />Utility Account No <br />Permit Fei $ <br />Connection Charge <br />Trunk <br />Latera! <br />CHART NO. <br />IV/ (0/q <br />$ — 450.0( <br />Total Connection Charge $ _. Mg go <br />Utility Development Fee <br />Water $ 224.9e — <br />Sewer $ 589 00 <br />Total Development Fee $ 813.00 <br />Sewer Bond District fiend IEM <br />Abutting Lot Line <br />N, S, E, W <br />Type of Permit Approved By <br />Remarks <br />IMPORTANTI <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Issued By <br />Customer Signature <br />ft. <br />Inspection By — <br />Date Inspected �— 2 `'-- <br />INSPECTION <br />No. 28001 <br />