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+�verett <br />City of Everett <br />Sevver Application anc� Permit <br />NO. 7$ O 7 A� DATE 2- �l - 9) <br />Service Address 1S� 9 � 1�� Utility.4ccount No. <br />Billing Address <br />Ciry, State, Zip <br />Owner <br />^.onnection by �� {�T n � � Up y{ '�t <br />Address <br />Phone <br />Legal Description: <br />Lot <br />Block <br />Plat <br />Unplalted Description: <br />Type af Permit � � i' <br />Remarks �, ri n Gn ��Z��� �+6,� n o r� �ify�t <br />� <br />�ti� ,�� � rMP�� � <br />TANT! <br />CALL 1-800-424-5555 48-HQURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />SEE SKETCH kTTACHED <br />CHART NO. <br />��/� ��� �> 3� <br />Permit Fee $ <br />Connection Charge <br />Trunk <br />Lateral <br />Totai Conner.tion Charge <br />Utility Development Fee <br />Water <br />Sewer <br />Total Development Fee <br />Sewer Bond District <br />Abutting Lot Line <br />N, S, E, W <br />$ <br />$ <br />$ <br />Approved By <br />Issued By ��af2Lv N3 � � �@ Ir <br />Customer Signature <br />�yJ�,�� 8 ' .� . <br />�� G q �1� ',�-/ a� m �a <br />��� � a�� � ,v � �,�� <br />u� <br />Inspection By '� , � �I <br />Date Inspected � -� � - � / �� <br />,. ,� j <br />�-,3"`' `P� � i <br />rdo.2g�74 ��;� � <br />.;/1 i <br />UTILITY BILLWG I <br />