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' everett <br />�e� <br />City of Everett <br />CHART NO. <br />To Pos+' ny <br />mot— 1S-51 <br />Sewer Application and Permit <br />NO. 28197 DATE Aj=ii 2 1-991 <br />Service Address 10217_a 7th awa ar Utility Account No. <br />Billing Address <br />w � <br />City, State, Zip ftexatt, HA 92309 <br />Owner a" ga=z0V <br />Connection by TSI <br />Address <br />Phone <br />Legal Description: <br />Lot <br />Block <br />Plat <br />Unplatted Description <br />Type of Permit <br />Remarks <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 />Permit Fee $ ao.00 <br />Connection Charge <br />Trunk <br />Lateral i1 /0-$9 <br />7w-A 906ARR 11 <br />Total Connection Charg%011?.diia <br />Utility Development Fee SEW-rp <br />; 0,(10 <br />40002819-( <br />Water Kl if f. <br />a 0.00 <br />CF>FCt1 <br />„u.uu <br />Sewer $ <br />Total Development Fee $ <br />Sewer Bond District <br />Abuttin,j Lot Line <br />N, S, E, W <br />Approved By <br />Issued By J Rock—lI <br />Customer Signature <br />inspection By _ <br />Date Inspected t111/`�/ <br />RvBPc� i iC;! <br />NO. 20197 <br />ft. <br />