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everett <br />�e <br />City of Everett <br />Sewer Application and Permit <br />No. 2831 S DATE <br />CHART NO <br />Se n 1 <br />Service Address 3:94}1 pth A4 e. SP <br />Utility Account No. <br />Billing Address —saw _ <br />City, State, Zip n <br />Permit Fee $ 'in_oo <br />Owner i <br />Connection Charge <br />Connection by <br />Trunk $ <br />Address <br />Lateral $ <br />Total Connection Charge $ <br />Phone__ <br />Utility Development Fee <br />Legal Description. <br />Water U6120/91 y'`8'if n9fWiilSfNJ <br />Lot <br />Sewer i?E315 <br />Block <br />Total Development Fee CIIF.('f'. uo.go <br />Plat <br />Unplatted Description: <br />Sewer Bond District <br />Abutting Lot Line <br />— N, S, E, W ft. <br />Type of Permit flow cannsec <br />Approved By <br />Remarks <br />Issued By P Rain <br />T io 73o <br />Customer Signature _ <br />IMPORTANT! <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259 8810 FOR INSPECTION Inspection By� / <br />Date Inspected / <br />SEE SKETCH ATTACHED NO. 28315 <br />INSPECTION <br />