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� <br /> CHART N0. _ - -- <br /> ' everett <br /> �n� {'p' Dvs�,k�, <br /> I <br /> 7•- Z6 -4/ <br /> City oi Everett <br /> S�wer Appfication and Permit <br /> u� 1�. ��� i:. a�n ��NNiN'1�.... <br /> � <br /> r,a. 28356 DATE _ �++t^v 17 �9s1 ' <br /> 609 — 100'th Pl 8B �IlMwl'•'C:'r. <br /> Service Address -- -- Utihiy AccouN No. i�+�� s u+ n+ — <br /> BIIIing Address <br /> 12209 fi ian� � !�� � � � ;n.nn I <br /> City, State, Zip u g�n�- �� �Sa Permit Fee $ �0.00 <br /> Owner _�11�sop�rtA�s Connec0on Charge i <br /> Connectlon by �„�,^�,,,e;,� Trunk S — � <br /> Address pp M— ++^� Lateral S I <br /> I �s.�..,.tt, ri on�p,l Total Conneclion Charge E I <br /> � <br /> Phone _;,■�—�i�+ —. Utility Developmenl Fee j <br /> Legal Descriptlon: Water $ I <br /> Lot --_. -- Sewer 3 I <br /> Block — Total Development Fee $ -- <br /> Plat <br /> IUnplatted Descriptlon: _ Sewer Bond Dlstrict _— <br /> � __ _,__.. Abutting Lot Line <br /> — �-- N� S, E, W -- — h' � <br /> Type ol Permlt t� m�atazot _ _ Approved By <br /> Remarks _�Y� Issued By— <br /> I <br /> _ Customer Signature — <br /> � IMPORTANT! I <br /> CALL 1-800-424-5555 48-HUURS f <br /> PRIOR TO DIGGING �� �/-/ I <br /> I Inspection By� /����11'./ <br /> CALL 259-8810 FOR INSi�ECTION / i <br /> Date InspeCled — ��-��`�� � <br /> SEE SKETCH ATTACHED No. 28356 � <br /> � �N^f'PCI�ION � <br />