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e� erett <br />ti <br />I� ,: <br />�. <br />Clty oi Everett i � � <br />S�ewer A►�plication and PErmit <br />°� _,��, <br />NO. �l�L, '.. 1 <br />z�.} 1 DATE _�u, �yay__— <br />ServiceAddress �» - ����r e1 --_ <br />DIIIIrgAddress G9i -'^--..,�-^r� -- <br />Ciry, State. Zip - — <br />Owner — <br />Connection Cy _�ys� -�� - <br />Address <br />Phone � <br />Legel Descriptlon: <br />Lot <br />Block <br />Plat — <br />Unpletled Descrlption: <br />Type of Permit p� ..�.�....�=q� <br />Remarks <br />IMPOF�TANTI <br />CALL 1-800-424-5555 48-HOUP.S <br />PRIOR TO DIGGfNG <br />CALL 259-8810 FOR INSPECTION <br />SEE SKETCH ATTACNED <br />Utllity Account No <br />CHART NO. <br />s����J 1� �,�.t�/.,<<� �� a-q� <br />Permit Fee $ _ �pp____ <br />Connection Charge <br />Trunk <br />Lateral <br />Total Connection Cherge <br />Utility Development Fee <br />Water <br />Sewer <br />Total Development Fee <br />$ <br />E <br />$ <br />$ <br />$ <br />$ <br />Sewer Bond District <br />Abuding Lot Line <br />N, S, E, W_ n. <br />Approved By — <br />Issued By —d <br />Customer Signeture ____ _ — - <br />��, i , - i <br />Inspection 8y _ _- � <br />Date Inspected _ _— ��.��� <br />!,�i�.r�rcii��r.� <br />No. 28231 <br />