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1 <br /> � <br /> ' <br /> I <br /> CHART NO. ______ _ <br /> everett �1 I <br /> G)��N� io (� o�SliN � � <br /> 7-y -� / ( <br /> Clty of Everett <br /> Sewer Application and Permit <br /> �'1�. 28332 DATE i-]-91 u: n. � ,i :i�nm iuum�i. , , <br /> t!fMMI,�'.T: <br /> Service Address _ �17 1nOth ?1=t:_ Ulility Account No. . <br /> tfrwpl"�.-�'� <br /> BIIIIngAddress — s�� ���ch P1 sc i,��a ,�t� �� <br /> Clty, State, ZIp — <br /> &veratt i1A 9f:204 Permit Fee $ ��_�y���`'�� F�S.11f� <br /> Owner tincolu D lcaccer Connectlon Charge <br /> ConnecUon by A M G�tewrwl (l+n�trn�tnra. j�` Trunk $ — <br /> Address _ »2t 94th Ur S� Lateral $ <br /> � <br /> Jiv�re[L 1IA 502U5_ _ Total Connection Cherge $ - i <br /> Phone _33a-����� _ —_— Utlliry Development Fee I <br /> Legnl Descriptfon: Water $ _— <br /> Lot ._ _ — Sewer $ — <br /> Block Total Development Fee S <br /> Plat _ <br /> Unpleded Description: — 5ewer Bond District _ — <br /> Abutling Lot Line <br /> -- N, S, E, W --- -- (t. <br /> Type ol Permit ner conneetion _ Approved By <br /> t <br /> Remarks t/l� 73� _ _— Issued By .-21n111 �i �ti-- i <br /> _ ___ Customer Signature ` -- � <br /> IMPORTANT! <br /> CALL 1-500-424-5555 48-HOI�RS <br /> PFiIOR TO DIGGING � <br /> � � /�� / � <br /> CALL 259-8810 FOR U ISPECTION �nspection ey� / /��a� C%(�-�--_ � <br /> Gate Inspected �' � /�� — � <br /> � <br /> SEE SK�TCH ATTACHED No. 2833� <br /> I <br /> i <br /> � <br /> 1��15�'LCl ION � <br /> l <br />��_ <br />