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everett <br />,,e <br />S <br />0 <br />City of Everett <br />Sewer Application and Pe-trifit <br />i, <br />NO. 28047 DATE 11crem ox 2, reran <br />Service Address <br />Billing Address <br />2409 21st St <br />Utility Account No. <br />City, State, Zip rr 6;A WOW Permit Fee $ <br />Owner Connection Charge <br />Connection by Trunk $ <br />Address 13911 uw 99 Lynnwood. WA 9t3037 Lateral $ <br />Total Connection Charge $ <br />Phone 74� a3 lba Utility Development Fee <br />Legal Description: Water $ <br />Lot Sewer $ <br />Block Total Development Fee $ <br />Plat <br />Unplatted Description: <br />Type of Permit xpipai]r <br />Remarks CO 0400h C`p <br />eyls Co,r�. PYG <br />IMPORTANT! <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259.8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Sewer Bond District <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />10.00 <br />Issued By <br />Customer Signature <br />Inspection By <br />Date Inspected / z SU <br />INSPECTION <br />NO. 28047 <br />ft. <br />n <br />