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everett <br />�e= <br />u <br />City of Everett -� <br />Se�uver Application �nd Permit <br />. i . _ <br />NO. I'B ����' DATE --1:��- L.�11L—_ <br />ServiceAddress —98u7-t4t1:-�+zSi -- ----- <br />Billing Address , <br />Ciry, Slate, Zip �an«l.e wa 9nl��a — <br />Owner <br />Connectlon by _ <br />Address _ -- <br />Phone �47-0213 -- — --- ----- <br />Legal Descriptlan: <br />Lot �--- — — — <br />Block , . - <br />Plat l:uthcLlII __ — <br />Unplatted Descriptlon: _ - <br />Type ol Permit __ u � t -- <br />Remarks _ - <br />IMPORTANTI <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Utilitv Acrount No. <br />Permit Fee $ <br />Connection Charge <br />Trunk <br />r,HART NO. — <br />SPn�' � ��o��,Ttj -5�rr--rir <br />io rosriNc __��__=r�5� <br />Lateral <br />Totel Connection Charge <br />Utility Dovelopmen� Fee <br />W ater <br />Sewer <br />Total Development Fee <br />� ;�,i�; � <br />3�. <br />g _ ll`�.00 <br />��� nn <br />— — --.^� <br />$ 65r,.00 <br />Sewer Fond Disiric� ',.r�-}a°tlsid� I <br />Abutting Lot Line �I <br />N, S, E, W— R. i <br />I <br />Approved By I <br />Issued By '�arvaret licLeod <br />Customer SlgnaWre <br />Inspection By � ' <br />Date Inspected _ _ _�.���n <br />No. 28167 <br />