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everett <br />�e� <br />City of Everett <br />Sewer Applicat <br />No. 2FG*? <br />:4 <br />'r <br />ion and Permit: <br />DATE b ^ 1!4; <br />Service Address 10804 7th A . C F Utility Account No. <br />Billing Address d3 1 <br />City, State, Zip imerett U& n^709 Permit Fee $ <br />Owner Poh"stu—LrSewtr Connection Charge <br />Connection by A.A. Sanitary �kau- . Co. Trunk <br />Address 11911 ryyr on --_ Lateral <br />CHART NO, <br />TO POSTING__-3 zLz <br />(t <br />T y yn' 111 Qan•17 _ Total Connection Charge $ <br />Phone Utility Development Fee <br />Legal Description: Water $ <br />Lot Sewer $ <br />Block Total Development Fee $ <br />Plat <br />Unplatted Description: <br />Type of Permit =rw cc ar -cti� <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 />Sewer Bond District <br />Abutting Lot Line <br />N, S, E, W _ <br />Approved By — <br />Issued By <br />Customer Signature <br />Inspection By / <br />Date Inspected <br />INSPECTION <br />NO. 28623 <br />ft. <br />