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i <br /> everett <br /> CHART N0. <br /> � <br /> � � � t c,-n �,�.-, <br /> N c� .Z. . �j c� <br /> City of Everett - - <br /> Sevver Ap��licatio�rt ar�d :P�rr�it <br /> , � _� <br /> _ :4 — <br /> NO. 2 7���_ �lATE �ntamt�r to, t oop <br /> i <br /> Service Address —38e8 �5�h s� Utiliry Account No. � <br /> Billing Address <br /> . . ox _ �— <br /> City, State, Zip ������ �Q036 Permit Fee $ i� �� <br /> I <br /> Owner Connection Charge <br /> Connection by • ' .,�Ni TF_ P/un+h,.r� Trunk $ I <br /> d <br /> Address Lateral <br /> $ — � <br /> Total Connection Charge $ __ I <br /> — i <br /> Phone 7d5_�'idq Utility Development Fee j <br /> Legal Description: Water g <br /> Lot Sewer <br /> $ <br /> I Block Total Development Fee $ <br /> � Piat <br /> Unplatted Description: Sewer Bond Distric! <br /> Abutting Lot Line I <br /> N� S� E� W (t. � <br /> Type af Permit ���r�t fo== Approved By <br /> Remarks Issued By _r.�:,.qn,-�,� �r�i,a�� I <br /> — Customer Signature � <br /> IMPORTANT! � <br /> I <br /> I <br /> CALL y-800-424-5555 48-HOURS ; <br /> PRIOR TO DIGGING � i <br /> � Inspection By =_ � <br /> CALL 259-8810 FOR INSPECTION ��{ G � I <br /> Date Inspected '"" ? 3 - �� � <br /> I <br /> SEE SKETCH ATTACHED NO. 27���•.� I <br /> I <br /> _ . _ � <br />