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��� <br />1.,,1�1 <br />everett <br />e <br />CHART NO. <br />TO POSTING << _ <br />y`��.,- Y-- <br />City of E�erett :' ? : � � t= <br />. � . `rt��- <br />�ewer 14pplication and Permifi �__� � �, ` <br />' _ .Sq� G��+S^r <br />' ' '", .� ., y. '3 � � ��• M1 <br />� '�'-= - <br />NO. 2 $13 Z DAT� _. � <br />Servlce /lddress — <br />Billing Address — <br />City, utete, Zlp — <br />Owner <br />Connection by _ <br />Address — <br />Phone <br />Legal Desr,riptlon' <br />Lot <br />Block — <br />Pla� <br />Unplatted Descrlptlon: <br />Type of Permit <br />Remarks _ <br />IMPORTANTI <br />� <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Ulility Account No. <br />Permit Fee E � <br />Connection Charge <br />Tr�nk $ <br />Lateral a <br />Totel Connection Charge 5 <br />Utility Development Fee <br />Water $ <br />Sewer a <br />Total Development Fee S <br />Sewer Bond District <br />Abutting Lot Llne <br />N, S, E, W — <br />Approved By — <br />Issued By -- <br />Customer Slgnature <br />� � � <br />Inspection By ���-� <br />/, <br />Date Inspected _-1� � �— <br />� ir :� <br />.,, ; A132 <br />