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everetl <br />� <br />City of Everett <br />i� <br />' ' � � f^, ,J :. <br />l . L'. 'Z: � L: � <br />_ _ = . - :'; - <br />CHART NO. <br />F�2 C;.ti��2,-,,,� <br />. . - . . <br />Se�nrer A�plicatio�n �nd Pe�m�t . ._ � <br />. i.: �J ` ' � _ <br />'�� � _ .� � "i r .� ' �. <br />. '� - '_ � � ' ' �; : _' � <br />275�9 �. -=�:- =._�-�_�_: _ � <br />NO. D/k'fE . ��arch�2� �eoo� <br />Service Address Utilit�, 4ccount No. <br />Billing Address <br />City, State, Zip <br />Owner (Mortaagor) , <br />Billing Name _ <br />Connection Dy <br />Address <br />0 <br />Phone II27—R1SF <br />DESCRIPTION: <br />Lot � <br />Plat Glenhaven rieiahta <br />Unplatted Description <br />Type Perrc.it: <br />Remarks: <br />IMPORTANT! <br />C�LL 1300-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-88'li FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Permit <br />Connection Charge(s) 7�n_oo <br />Total Fee '+�_no <br />Utiltiy DereloF::^nY Fec Ord. 11?1-A5 <br />water 179.00 <br />eewer h71.00 <br />G�0.00 <br />Sewer D <br />Mon;hly Sewer <br />Monthly Sewer Constr. <br />Trunk 110 OG <br />Lateral <br />Abutting Lot Line <br />N, S, E, W. <br />A�proved By_�n�p T ��ny�, <br />CitV Engmeer <br />Issued By Sus� Fsu3a^ <br />��_� �� -- <br />Inspec[ion By — "� <br />Date I <br />I i."�.�' C.:: I�i Gl�i <br />/ �� y/ -S� <br />N0. L ! �J`F� <br />