Laserfiche WebLink
everett <br />City af Everett <br />_� o�ST►NG � <br />Sewer Applicati�►n and Permit <br />N0. 2$ i 9 O DATl� ��y, ioai <br />Service Address ��_.}eSth !} �e - — <br />Bllling Address T� • ae =....,.r� W� i���a. _ <br />Clty, Stete, Zlp <br />rJwner -- — - <br />Connectian by <br />Addresa <br />Phone �s��sne <br />Lepel Description: <br />Lot �_ _ <br />Bla;k _ <br />Plat _�s1s 1�iat �4►r-0 <br />Unpletled Descriptlon: _ <br />fype of Permd ��_ <br />Remerks __ __ <br />IMPORTANTI <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />SEE SKETCH ATTA�CHED <br />Utility Account No. <br />Permit Fee S _10 DO <br />Connoctlon Charge <br />Trunk S 7�o DO <br />Lateral a <br />Total Connectlon Cherge S 31�.00 <br />Ulility Development Fee <br />water 3 i�o.sa <br />Sewer a In_nn <br />Total Development Fee S fB0.o0 <br />Sewer Bond Dlsirict �n 7*� <br />Abutting Lot Lina ��'�%��"'1 :-�S�X�M Ufi0RN1,;4n i! 1, <br />N� S� E, W_ fl0000i1o? fl. <br />NqTEF 1��'i0.f1U <br />Approved 8y wrrna�ai <br />�"WEF i YI.(M1 <br />Issued BY J fesaler�}} �MMiE� 1 ♦�in In <br />Customer Signeture _ � � � � �� ��*��'�� <br />: i f d,� • lii.d.'.ifl <br />17.F1G Yt�i.lYl <br />til'tyl Y°O.�ll <br />�y1� �ai �:.n. �.. <br />i: =�:ni ���.� �_ <br />�Ji���.�rr - . ;' <br />Inapection By = <br />Date Inspected <br />INSf'EC1lON <br />No. 2819U <br />