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Sewer Application and Permit <br />28972 DATE 11-20-92 <br />Service Address 10723 7th Ave SL <br />Billing Address same <br />City, State, Zip Everett WA 98203 <br />Ownor Bruce Bronson <br />Connection by AM General Inc <br />Address __ 1726 94th Dr SE <br />Everett WA 98205 <br />Phone 334-2140 <br />Legal Description: <br />Lot <br />Block <br />Plat <br />Unplatted Description: <br />Type of Permit New Connection <br />Remarks Permit expires Jar.. 20, 1993 <br />IMPORTANT! <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />CHART NO. <br />TO POUlf1c ,�:_Lf"4,� <br />I <br />t.t/207 5:0,1M 00MR6871 rt' <br />— — <br />i <br />110002m, <br />Utility Account No. <br />SEWER $30.00 <br />CVE011 $30.00 <br />Permit Fee $ 30.00 <br />Connection Charge <br />Trunk <br />$ <br />Lateral <br />$ <br />Total Connection Charge $ _ <br />Utility Development Fee <br />Water <br />$ <br />Sewer <br />$ <br />Total Development Fee <br />$ <br />Sever Bond District <br />Abutting Lot Line <br />N, S, E, W ft. <br />Approved By _ <br />Issued By / <br />Customer Signature, <br />Inspectioneel <br />By� <br />Date Inspacted�— <br />SEE SKETCH ATTACHED <br />INSPECTION 28972 <br />