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everett <br />�� <br />Z <br />f <br />t <br />City ot Everett, � y <br />Sewer Ap�lication and Permit <br />�, a�,� <br />I N0. � $ �.i1Q DATE . <br />Service Address �07 - L0+-1 al <br />Bllling Address " " <br />Clty, Ste1B, Zlp ��t� NA 98208 <br />�Wf18f oleilu�rA II*.If.r <br />Connectlon by �+..- e�« <br />Address <br />Phone 73�1-6717 <br />Legal Description: <br />Lot -- <br />Block <br />Plat <br />Unpletted Descrlptlon: <br />Type of Permit Ni1i COt7NSCTION <br />Remarks � �+�+ <br />IMPORTANTI <br />CALL 1-800•424-5555 46-HOURS <br />PRIOR TO DIGGING <br />CALL 258-8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Utllity Account No. <br />CHART N0. <br />j[��l 1.���s�.,-, 4,� 3 `I/ <br />, <br />Permit Fee $ �a•00 <br />Connectlon Charge <br />Trunk <br />Lateral <br />Total Connection Charge <br />Utility Development Fee <br />Water <br />sewer <br />Total Development Fee <br />Sewer Bond Dlstrict <br />$ <br />a <br />$ <br />$ <br />a <br />$ <br />Abutling Lot Llne � <br />N, S, E, W R. � <br />Approved By ._ I <br />Issued By —s�lpok�wll ! <br />Customer Sfgnature _ ' <br />F <br />Inspection By — <br />Date Inspected _ � <br />iri�:��rrTi�N <br />No. 28230 <br />