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- ... ,�.. t-.�,...,�..._.. � . .., , . .. , �y:,"�Sd�.� ,_,rT:�<T"�S?,-.�s;- a�,-�__ '-.T,X;i�,:..�..-.•—�^_. _._ . ._ . ,... .�.. . ... . . <br /> CHART NO. �, <br /> T� P(�STIN�f __ �s � �r <br /> Sewer Application and Permit <br /> � '� 29033 <br /> • DATE 1/1�/93 <br /> Service Address 11425 19th t.ve SE (Bidg B) Utiliiy Account No. <br /> Bflling Address 8505 NE Bochell Wy <br /> Bothell WA 9B011 U�/^'=��' 7�j4db�� OUt�R4l8174 Ct::'"� <br /> City, State,Zip Permit Fee $ <br /> Owner mn �h6ott _ Connection Charge ���`�f��t'� <br /> F4.fF: �"rp.00 <br /> Connection by Trunk Pa•IO�II �b705.32 <br /> �SI : ? . . <br /> Address Lateral HO��'9n1E <br /> SEWEk 370.M <br /> Total Connection Chargekf00d�'.YO�o <br /> S[WER �70.Q0 <br /> Phone Utility Development Fee �p�gp2p <br /> SEI�" fi i'U.00 I <br /> Legal Description: Water Et�� �� <br /> Lot Sewer 5FW� � �'�.00 <br /> i:F1E!t•. b r,r•..� <br /> Block Total Development Fee $ <br /> Plat <br /> III <br /> Unpiatted Description: Sewer Bond District <br /> Abutting Lot Line <br /> N�g� E�yy ft. <br /> Type of Permlt Nw co�ection _ Approved By <br /> Remarks Issued By �B <br /> Customer Signature �'��� �-'��—��� <br /> IMPORTANT! <br /> CALL 1-800-424-5555 48-HOURS <br /> PRIOR TO DIGGING <br /> CALL 259-8810 FOR INSPECTION �nspection By <br /> Date Inspected <br /> SEE SKETCH ATTACHED <br /> r. <br /> INSPECTION - - �'" ` <br />