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�� <br />! everett <br />� '.. <br />� - 1 ": f., ,,,,r{ � � �? I <br />City oi Evereri : : , - ; � <br />� <br />Sewer Application and Permi�; ,,; <br />_#, c <br />_ . r��-� <br />- � _ �. � .;, _ � <br />NO. 2 S �. �� DATE <br />-�l� c.�S{�N cr SC— <br />Servlce Address ��--- <br />_ �_ <br />BIIIing Address <br />CIry, Stete, ZIP �� �--�-T i F n%R Q o�(1 � <br />Owner <br />Connection by _ <br />Address <br />Phune - <br />Legal De�cription: <br />Lol ��— --- - <br />Block <br />Plat � l � " - � — <br />Unpletted Description: <br />Type of Permit <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 ATTACHED <br />Utllity Account No. <br />�HART NO. <br />TO POSTING _ �� <br />� <br />Peimlt Fee $ � � � <br />Co�nection Cherge <br />Trunk <br />Lateral <br />Total Conneclion Charge <br />Utility Developmenl Fee <br />wa�e� <br />Sewer <br />Total Jevelopment Fee <br />Sewer Bond Districl <br />Abutting Lot Llne <br />N, 5, F, W _— <br />Apptoved By __ — <br />Issued By __— <br />Customer Signature <br />� <br />$ <br />S <br />S <br />$ �-,n nn <br />� ii ; i ��— <br />S —� c r, fa--d---'-r�--- <br />n. <br />Inspection By ����—'"� <br />Dale Inspected _ 9� 5 4/ <br />No. 28133 <br />