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i <br /> �� <br /> � <br /> CHART N0. <br /> I everett � <br /> �o �os.C.;�y <br /> _ g- zs-9i <br /> a <br /> Clty of Everett t - _ ' _ r <br /> Sewer A li�atian .and Permit ( <br /> Pp_ : _ . : ;. _ <br /> = h � - <br /> �R t <br /> NO. �$Q��� DATE ��� __ <br /> Servlce Address UUlity Account No. <br /> Bllling AddfeSS " • <br /> Clty, State, Zlp �z�tt Mr 9A]OQ Permit Fee $ 3�•� -- <br /> Owner JnT.�. o`n.++..�* Comection Charge <br /> Connectton by Trunk S __ — <br /> Address 179R _ Qdfh m a� Lateral 5 — �— <br /> Totel Cor,n�:ction Cnerge $ _--- <br /> Phone 37�'21�� — — Utilif/ Developme��t Fee <br /> Legal Descriptlon: Water $ <br /> Lot Sewer $ <br /> Block Total Development Fee S — <br /> Plat <br /> Unpletted Descrlption: ___ Sewer Bond Di�trict — <br /> ____ Abutting Lot Line <br /> -- -- N� S, E, W ft. <br /> Type of Permlt �ra mnnrrrr.a Approved By — <br /> Remarke _ ._ _ Issued By—,+ �-,__,_��-�,.�----. <br /> _____ __ Customer Signature _-_ , <br /> IMPORTANY! <br /> CALL 1-800-424•5555 48-HOURS <br /> PRIOR TO DIGGING /� � � ' �-- <br /> �'/ �� <br />� CALL 259-8810 FOR INSpECTION In�.pection ey�_. ->`�'���""� — <br /> , /P�S�.� <br /> Date Ir. pected _ . ____ --- <br /> SEE SKETCH ATTACHED No. 2 E3 Z O G <br /> INSPf_CTION <br />� I <br />