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everett <br />City of Everett <br />.'r -�os�'�� <br />rG�l����/ <br />�ewer Application and Permit <br />NO. � R Q;� S DATE s�� n.� �e, � om <br />Servico Address 627 - l0yrd rl s�s <br />Billfng Address - " " „ <br />City, State, Zip —�r�y��. <br />Owner r- .�. Jti� +•- <br />Cannectlon by -_ <br />Address 1726 - 9�.� �. ag __ <br />ttre�tl� 4111 9BiAS <br />Phone ����� _ <br />Legal Descri�tion: <br />Lot _ _ _ <br />Block -- <br />Plet _ <br />Unplatted Descriptlon: _ <br />Type of Permll _ � ���=pp <br />Remarks _ r.*n �+0 __ <br />IMPORTANT! <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Utility Account No. <br />CHART NO. <br />�� �i��>� �..:;.���� �un�;,,�u i��. <br />�,�at:ti ,� <br />�i$k ��O.iai <br />�IACt' 4'li,�d'� <br />Permit Fee $ �__ <br />Connection Charge <br />Trunk $ <br />Lateral E <br />Tolel Connectlon Charge $ <br />Utiiity Developmenl Fee <br />Water $ <br />Sewer $ <br />Total Development Fee $ <br />Sewer Bond Dlstrict •�,•!+ �+� <br />Abutling Lot Line <br />N S, E, W ft• <br />Appioved By <br />Issued By _��; <br />Customer Signature <br />' j' -r-j `� <br />Inspection B� _ <br />Date Inspected — <br />ir�i:,��i � u�,r, <br />No.28435 <br />d <br />