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, <br />eve,rett <br />City of Everett <br />Sewer Application and Permit <br />NO. 28�i79 DATE 2- �l - 9 1 <br />ServiceAddress a��� �� �'d" UtilityAccountNo. <br />Billing Address <br />City, State, Zip <br />Owner <br />Connection by � e.]�'���' ��� r��'�"� <br />Address <br />Phone <br />Legai Description: <br />Lot <br />Blodc <br />PIaC <br />Unplatted Desc�iption: <br />Permit Fee $ _ <br />Connection Charge <br />�Trunk $ <br />Lateral $ <br />Total Connection Charge $ <br />Utiliry Development Fee <br />Water <br />Sewer <br />Total Development Fee <br />Sewer Bond District _ <br />Abutting Lot Line <br />N, S, E, W <br />$ <br />$ <br />$ <br />n. <br />Type of Permit ��n r� n r f Approved By . <br />Remarks `� c�Q. S o_ ,,� c� i; . r �<_,� - Issued By .-��.n a M �%/A � — <br />.,) � � % � � %'T A.� ci �' F� �/ �/, �' i � �� Customer Signature � „ <br />/,��n� ��.� �.�-� To e d ��, o� tiy��� � v� i idit . e� /1 ��� 8� 8 <br />T IMPORTANT! M q,,,,, �,��/ �� �� 6 r 8 ?en_ �, /YI A�.� 2. o'_/� <br />�FS/7 L/:;i iUP 0� S7fInJ �D��¢ �'!i. <br />CALL1-800-424-5555 48-HOURS .y, �� P/L: ���y� �cJ c� /h�� � l��/Z4. <br />PRlOR TO DiGGING n <br />CALL 259-8810 FOR INSPECTION Inspection By , l/n�� — <br />Date Insoected <br />SEE SKETCH ATTACHED <br />� Fs� ti U, � ,—o � <br />,�.�� s "� @ <br />/.a� 7 ' Gc, o L /11l / <br />/ <br />UTILITY BILLING <br />S,-,,,��; p,P� -7'�. <br />@�� e �0.`�2'8�� l�9 <br />