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everett <br />Citlr of Everett <br />S�wer Application and Permit <br />No. 28324 DATE a�,,. z�, iyo� <br />CHART N0. <br />TO POSTING �� <br />flh;'.:!'Ui 1_I�Q.�bi LIfIL�('ISIl�'•�� ,....� <br />N110��`.ff i2'! <br />s�:��,.� �.,v.;� <br />�'t�t�:r ���n.tvz <br />Service Address 3003 - l�ih St Utility Account No. <br />Billing Address " ^ <br />Cfty, State, Zip S+.�tt, r� 9a�o� Permit Fee $ 10.00 <br />Owner �•l�ns 7Cock�.y Connection Charge <br />Connection by ��t�h gesdt R�aa�. <br />Address 9303 - 60th Ds-� <br />Phone 653-1979 , <br />Legal Description: <br />Lot <br />Block <br />Plat <br />Unplatted Description: <br />Type of Permit ALTERATZON <br />Remarks __ <br />IMPORTANT! <br />CALL 1-800-424-5555 48-HOURS <br />�RIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Trunk <br />Lateral <br />Total Connection Charge <br />Utility Development Fee <br />Water <br />Sewer <br />Total Development Fee <br />Sewer Bond District <br />Abutting Lot Line <br />N, S, F, W _ <br />Approved By <br />Issued By J.�»ckiaall <br />Customer Signature <br />$ <br />$ <br />$ <br />$ <br />$ <br />$ <br />Inspection By -��-��''��� <br />Date Inspected G 2 7- i � <br />INSPECTION <br />No.2.s3�a <br />ft. <br />