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everett <br />City o1 Fvarett <br />CHART NO. <br />5 ea+ fo pasf, Nq G-r8 -4� <br />Sewer Application and Permit <br />r�c�. 2 8?.. 3 3 DATE _�/�9i ____ <br />Service Address — ��+ +�+sa_-p1aa�-�s--- Utility Accoum No. <br />Bllling Address 11511 lblwas Point Dr <br />City, State, Zip r� rti.�e wx �Rn�a Parmit Fee $ <br />Owner porothTllIIlano'iasd <br />Connection by _ R. fi�„����;�— <br />Address - <br />Connectlon Charge <br />Trunk S — <br />Laterel $ - <br />Tolal Connection Charge $ — <br />�o�.:.. 91 1:,^IFw IYIfWM6G90 <br />Phone _ ;���N _____. Utility Development Fee <br />Legal Description: Water <br />Lot t��?, �? �,s_ i�cti*�n Sewer <br />B!ock <br />P181 ____ <br />UnplaSted I)escriptlon: <br />Type o4 Permit �th �w.,.r Lte <br />Remerks _ <br />IMPORTANT! <br />GALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259•8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Total Development Fee <br />Sewer Bond District <br />Abulting Lot Line <br />N, S, E, W _.._. <br />Approved By _. <br />Issued By. <br />_ Customer Slgnature <br />tiiny�'si. .�� <br />�,F7A. ' . <br />riu r� s,o.m -- <br />$ <br />. -�. <br />�� ll s� /'�,(' <br />Inspectlon y i o 6 � <br />� ti � <br />Date InspecteJ r ^_1� -- <br />No.28233 <br />irvcr���c � �: �r� ; <br />