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evj!re#- <br />�e� <br />City of Everett <br />Sewer Application and Permit <br />NO. 28076 DATE 2- 7 - 9 <br />Service Address��� �+ <br />Billing Address <br />City, State, Zip <br />Owner <br />Connection by <br />Address <br />Phone <br />Legal Description: <br />Lot <br />Block <br />Plat <br />Unplatted Description: <br />Type of Permit <br />Remarks= <br />Utility Account No. <br />Permit Fee $ <br />Connection Charge <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, E, W <br />Approved By <br />Issued By ) oo ^1�k' <br />q� Customer Signature <br />-fir, ,C cj c p Xr v Doti/ �Z,�' � o! <br />IMORTAN J3' b ap Of S <br />o �aNS <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING Ir <br />CALL 259-8810 FOR INSPECTION Inspection By <br />Date Inspected �f— <br />SEE SKETCH ATTACHED <br />UTILITY BILLING <br />No.28O76 <br />ft. <br />