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� � � <br /> � � x <br /> a ti <br /> �xH � <br /> HxH <br /> � y � CHART N0. — <br /> � y H ev�rett ' <br /> Oy � <br /> � TO PUSTING � -�-�3 <br /> � <br /> ��' g I <br /> z H � City of Everett �� s ;� � � ,:•:s: _ <br /> � y 2 �� lNi b.rF6 <br /> g� H �ew�r Applica#ion and Pe�mit � �: �^ , s�� � ; <br /> C] t7 p� <br /> '.�d1Q,13 uJ <br /> � � ,,, 1_I!I.f' f;0.lA) <br /> [n ':i:+ili2F;`1;v8 <br /> No � i No. 28348 DATE ��, u, 13�z. . . . _. wT— <br /> i ;�qrnl2r�?�S�i � <br /> Service AC�1rEss �,9p0_=_1,2t� N�re ia - Fl}��- 2 Utiliry Account No. '�4'c�=�f� �� <br /> ;{(Iin.tN;`) � <br /> Billing Address i ,2a«n � nrh - R2oo ;[GLI.' k �G.CU ! <br /> Ciry, State,Zip <br /> annrv„a. ota aannc Permi[Fee $ 30.aii�i_!! '+1;D.t�J � <br /> O�vner —r,;a;�dow-aosa3 Connection Charge <br /> Connection by Trunk $ � <br /> Address Lateral $ � <br /> Total Connection Charg� $ , <br /> '�1 Phone 455�}0.,} Utiiity Development Fee II <br /> ��,' Legal Descrip�ion: Weter $ � <br /> ��' Lot Sewer $ - <br /> � � Block Total Development Fee $ � <br /> � <br /> '�' Plat I <br /> 1 �' Unplatted Description: Sewer Bond District � <br /> v, Abutting Lot Line I <br /> m� <br /> � N�S, E�W ft. <br /> Type of Permit .,r:�• rn��,�;; Approved By ', <br /> ! Remarks Issued By T n �t• �� ' <br /> � <br /> Cusromar Signature_ �I <br /> '�1 � <br /> '—' IMPORTANT! i <br /> � <br /> CALL 1-500-424-5555 48-HOURS I <br /> I PRIOR TO DIGGING //� p�// <br /> Inspection By 5��..�d ^ <br /> I CALL 259-8810 FOR I��SPECTION � // / _ � I <br /> iDate Inspected ,L� <br /> i <br /> SEE SKETCH ATTACHED NO. Z S 3 n� � <br /> i <br /> If�:S!'L=CllOi`J I <br /> a <br />