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� i <br /> r I� <br />•' , CHART NO. ' <br /> everett -" <br /> �Tv �os� ���9 <br /> �.; �- 18-91 <br /> � <br /> � <br /> City of �verett w � `' <br /> r: � � <br /> �.. .s <br />' � Sewer �pp�cation and Permit <br /> , �� r <br /> � �� � <br /> ' N0. �2�� DATE <br /> , <br /> Servlce Address 3g3g� - +�� �--- �� Utility Account No. <br /> ; Billfng Address <br /> i <br /> ; City, State,Zip � Permit Fee $ �p_nn <br /> X <br /> Owner �+��--a ��.- e__L Connection Charge <br /> 4. <br />; F Connection by ,h,i �._.._ ,.r_ _ Trunk $ <br /> s <br /> ; <br /> Address Lateral $ <br /> � Totai Connection Charge $ <br /> Phone Utility Development Fee <br />: " Legal Description: Water $ <br /> ` Lot _ Sewer $ <br /> J <br />� ` Block Total Development Fee $ <br />�` Plat <br />�i <br /> Unplatted Description: Sewer Bond District <br /> i <br /> Abutting Lot Line <br /> N,S, E, W ft. <br /> Type of Permit � ��,�� Approved By <br /> Remarks (Lin 730) issued By <br /> Customer Signature <br /> IMPORTANT! <br /> CALL 1-500-424-5555 48-HOURS <br /> PRIOR TO DIGGING ' � <br /> CALL 259-8$10 FOR INSPECTION Inspection e ��,��� � - � �� <br /> Date inspected �/�% /`�� ` <br /> SEE SKETCH ATTACHED No. 2HZO9 <br /> ii�SPECTION <br /> � <br />