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everett <br />Clty of Evereh <br />Sewer Applicat <br />N�. 28791 <br />A <br />�R <br />K <br />T � ' C Q <br />ii � �yS � <br />ior� �r�d P�ermit <br />�� ���^�� <br />DAfE `� 6/1�/9z <br />SO1 103rd !1 /R <br />Service Address ----- <br />Billlnp Addresa 22702 h5eb s.. v <br />City, State, Zip �►� '- T��* v� oaee� <br />Owner — -- `-- ---- Af-- <br />Conneciion by <br />Addresa <br />Phone <br />Lepal Deacriptlon: <br />LU ----- <br />Block <br />Plet __---- <br />Unplatted Descriptlon: <br />Type ot Permit <br />Remarke <br />IMPORTANTI <br />CALL 1-500-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259•8810 FOR INSPEGTION <br />SEE SKETCH ATTACHED <br />Utiliry Account No. <br />CHART N0. <br />TQ POSTlNG ��'s��'�-- <br />Perml: Fee $ 30.00 <br />Connection Charge <br />Trunk <br />Lateral <br />Total Connectlon Cherge <br />Utllity Development Fee <br />Water <br />Se�ver <br />Total Development Fee <br />Sewer Bond District <br />Abutting Lot Line <br />N, S, E, W — <br />Approved By _ <br />$ _ 330.00 <br />$ — <br />S — <br />$ 119.00 <br />a 471.00 <br />a 650.00 <br />Issued By ; <br />/ <br />Customer Signature - � � <br />Inspeclion By ' ' 'f ��' /�` �' <br />�_��,�t L <br />Date Inapected ----- <br />INSP�CTION <br />� <br />No.2a7s1 <br />n. <br />