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H <br />p�pH� <br />"+tl H hOfl <br />'Z <br />OH <br />a" 0 <br />HH <br />t' y <br />gCA <br />H <br />darn <br />ii � <br />O rn <br />ie <br />c o <br />City of Everettd G �, <br />Sewer Application and Permit <br />NO. ` 82 3� DATE ilpru 15 Inn, <br />Service Address . 110013 'tth Av s^ — Utility Account No. <br />Billing Address --i <br />City, State. Zip —1 w&+- 02"', <br />Owner <br />Connection by <br />Address <br />Phone _ <br />Legal Description: <br />Lot _ , <br />Block tOgs�'er wii1, an`easenent over the N 30' <br />of I.ot 2 broadoray fors xo 2 <br />Plat — <br />Unplatted Description: <br />CHART NO. <br />T�l F'MTING <br />Permit Fee $ 30.00 <br />Connection Charge <br />Trunk <br />Lateral $ <br />Total Connection Charge $ <br />Utility Development Fee <br />Water $ <br />Sewer $ <br />Total Development Fee $ <br />Sewer Bond District <br />Abutting Lot Line <br />N, S, E, W — <br />Approved By <br />Type of Permit iou <br />Remarks <br />IMPORTANT! <br />w <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Issued % <br />Customer Signature <br />Inspection W <br />Date Inspected <br />INSPECT;ON <br />No. 28213 <br />ft. <br />i <br />