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--. <br />everett <br />City of Everett <br />S�wer Applicatior� and P�rmit <br />NO. Z 7� 9 O DATE �rpb,r�a,—'—�o _ <br />Service Address Utility Account No <br />Bil!ing Address a . <br />City, State, Zip � Permit Fee <br />Owner <br />Connection by <br />Address; <br />Phone <br />Legai Descriptior,: <br />Lot <br />Block <br />Plat <br />Unplatted Description: <br />Type oi Permit _ � <br />Remarks _� �—�-�--- <br />IMPORTAPIT3 <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DlGGING <br />CALL 259-8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />�HART N0. <br />7� ��s�� ��,� r v�� f qi <br />�1�i,�t5;4`l. �:iU;;i r�t�;iy,;: . .,. <br />/ <br />',iDOn?`'.�� . <br />� 7 ;iti <br />I I'I ):i� ':i';.i:i) <br />..'.�.1 ii ':.��(:.l11) <br />,��i� c�i �.;.;��� <br />i: a>�.ii „�_n <br />• . �, .._.�„ <br />;:;1r�q''; •,,';Q <br />'-,Clt[I' � :t!,iFi <br />$ ���rl , ,. . <br />Connection Charge <br />Trunk <br />Lateral <br />$ <br />$ <br />Total Connection Charge $ <br />Utility Development Fee <br />Water $ <br />Sewer $ <br />Total Developmc�t Fee $ <br />Sewer Bond District <br />Abutting Lot Line <br />N, S, E, W _ <br />Approved By <br />ft. <br />Issued By -- <br />�, <br />Custon,er Signature � t ' __ ' - _— <br />Inspection By <br />Uate Inspecte <br />INS�ECTION <br />No.z79ga <br />� <br />