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� � � <br /> � � x <br /> C, H <br /> 9H �n <br /> i <br /> y i-�i <br /> � H � <br /> o x o CHART NO. <br /> yv H I everef# <br /> � y � � To �osrir�c �_-Z�-� <br /> H � g � <br /> �V n <br /> H Ir, i. i ;� �:i.i,i.. .,,., . . <br /> z� y City of Everett <br /> r H y . . ;,uo���i��•�' I <br /> g cn N ;laKfi� s:�.�3U <br /> Sewer Applicat�on and ermit � <br /> o l7 v� I ii�KlOze347 <br /> � � � '�,C41f1? t.j�i.�ai <br /> ;i;�ii}�f;.'.4t; �i <br /> y o v�i NO. 2 H 3 S O DATE Tsiy �� ,qo� _ .:, :-. .. . i <br /> ;;I itlti::[i,'v�5' <br /> Service Address �� ]�t �ve Sr — �'^; ''' Utiliry Account No. _ `Fes�' r -'� '�' <br /> I:ti�JU?i`_'r�t �, <br /> Billing Address ` 82�a �!'FC .:;'�.iul <br /> I.H:.�7; ;':�.:,r��. <br /> City,Stale,Zip �—��=Q:�; Permit Fee $ �n nn <br /> Owner , Connection Charge � <br /> Connection by . Trunk $ _ — <br /> Address Lateral $ <br /> Total Connection Charge $ � <br /> � 1 rhone 555-46ai Utility Development Fee <br /> O�' Legal Description: Water $ <br /> � ' Lot __— Sewer $ <br /> 0�� Block — Total Development Fee $ <br /> `�' Plat __ <br /> I <br /> ��� Unplatted Description: Sewer Bond District . I <br /> �1 Abutting Lot Line <br /> �' <br /> N, S, E,W h• I <br /> � <br /> '� Type of Permit � Approved By <br /> ��, Remarks — Issued By �.1� T^ �� <br /> � <br /> !-1 Customer Signature, <br /> / <br /> � IMPORTANT! <br /> � <br /> CALL 1-800-424-5555 48-HOURS <br /> PRIOR TO DIGGING � <br /> Inspection By� l .�r��-�l�j _ <br /> CALL 259-8810 FOR INSPECTION <br /> Date Inspected ����� G �� <br /> SEE SKETCH ATTACHEd No. 28350 <br /> I <br /> li!SPCCf10N <br /> a <br />