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everett <br />� ': <br />� <br />City of Everett �` � � � 4 � � � ` - <br />�'::�' ' �,-� . <br />Sewer l4pplica#ipn�,and Pe�•r�it <br />� ,..-,w5=_;:�,:- <br />- - u. <br />� "' — �'E._ y .= � ., . � ... � <br />N0. � ��� � DATE reNr�.r� ss, 1991 <br />Servlce Address z4u1 4dth st SY. <br />Bllling Address t514 li 16ch se _ <br />Clty, State, Zip &eattl� �� 9Ni01 <br />Owner Leonerco 2nc <br />Connection by <br />Address <br />Phone 547-u11� ____ <br />Legal Description: <br />Lot - � -- — — -- -- - <br />Block --- ----- <br />Plet r:���.�., itr _ <br />Unplatted Descdption: . _ <br />Type ol Permit _ Nw conetruction <br />Remarks <br />IMPORTAN71 <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 258-8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />UUlity Account No. <br />ICHART NO. <br />TO POST!N�_%' `'T <br />1'0 POSTING_ � � � a, <br />Perm�t Fee $ _ <br />ConneclL^n Charge <br />Trunk <br />Lateral <br />Totel Connection Charge <br />Utility Development fee <br />Water <br />Sewer <br />Total Developmont Fee <br />30,00 <br />E <br />S <br />$ <br />$ 1i9.00 <br />$ �71.00 <br />a G50.00 <br />Sewer Bond District __—_ <br />Abutting Lot Line <br />N, S, E, W <br />Approved By __ <br />Issued By — M�tg�ra[ MeLeod <br />Custamer Signeture <br />n. <br />Inspection By�� �k"��� I <br />Date Inspected _ _ _ � � _`!L� <br />No. 28129 <br />