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i <br /> � <br /> 1 <br /> ° CHART N0. <br /> � everett T �stt..y <br />� _ �l-l8-9 l <br /> ; CFty of Everett <br /> � Sewer Application and Permit <br /> � <br /> NO. '2$Z 9 6 DATE �,pr.iL2, t�Q� <br />` f <br /> � Service Address +���s 7Ch Mve ss Utility Account No. <br /> � <br /> � Billirig Address <br /> ' City, State,Zip ��-- Permit Fee $ ;p.�n <br /> Owner ���.a Connection Charge <br />: � Connection by Trunk $ <br />� Address Lateral $ <br /> Total Cor.nection Charge $ <br /> Phone Utility Development Fee <br /> legal Description: Water $ <br /> Lot :-ewer $ <br /> / Od.�O:�c,! �:��tIF'Pi OfN7t1N�.:1! 1":-!'% <br /> Block — Total Development Fee $ <br /> % SiUI�.���145 <br /> Plat g(_I,I�)> i::`si�.(Nj <br /> Unplatted Description: Sewer Bond District ''���`rr' <br /> _.. . . . �,��.�p� <br /> Abutting Lot Line �7�� U� io��,iql <br /> N, S, E, W h• <br /> Type of Permit Apprcved By -- <br /> Remarks Issued By—�* �tiw+�� <br /> Customer Signature <br /> IMPORTANT! <br /> CALL 1-500-424-5555 48-HOURS <br /> PRIOR TO DIGGING � <br /> � �� � :/, <br /> CALL 259-8810 FOR INSPECTION Inspection By � • � _ , <br /> Date Inspected � <br /> � r� <br /> SEE SKETCH ATTACHED NO. Z H I q� <br /> INSPECTION <br /> I <br />