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��� <br />O, y <br />C �+ <br />�H[n <br />y�� <br />�t c� <br />H 'oA <br />'�V M 'C <br />y� <br />�Z <br />o�d <br />��,8 <br />n� � <br />t"y� <br />Hy <br />N <br />M <br />C]�N <br />�HN <br />0 <br />everett <br />�e <br />, Clty of EVerett <br />. ; : :; I <br />Sewrer Application and Permit <br />N0.2i���� DATE __r•«Ctuaty_25�-I�inl—_- <br />Service Address =41:i �aw S� _[ _ <br />BillingAddress 1914 ti 14th St _ <br />City, State, Zip Seattle NA 9b1u3 _ <br />Owner __ ��T�erco <br />Connection by ____ — <br />Address _ -- <br />Phone s47-n�13 <br />Legal Description: <br />Lot — 4 -- <br />Block _ <br />F'lat �:utl�ria lII <br />Unpietted Descrlption: <br />� Type ol Permit <br />�i Remarks _ <br />new conncction <br />IMPORTANTI <br />CALL 1-800-424•55�5 48•HOURS <br />PRIOR TO DIGGING <br />CALL 259-8610 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />�HART NO. <br />TO POSTING �, - � <br />:� <br />� -: <br />Utility Account No. - <br />Permit Fee $ _____ <br />Connection Charge <br />Trunk <br />Lateral <br />Tolai Conneclion Charge <br />Ulility Development F-'ee <br />Water <br />Sewer <br />Total Development Fee <br />----- 3U.GG ---- <br />$ <br />� <br />$ <br />$ _ L74.U0 <br />$ 471.00 <br />$ _ n50.00 <br />Sewer Bond District _ _ <br />Abutting Lot Line <br />N, S, E, W fl• <br />Approved By — <br />Issued By-- `4r};aret �IcLeod <br />Customer SignaWre -_ ____— ---- — <br />Ins,�� n b� _L ,f�/' i�'✓) �f�i� <br />�"`-T�-Li' <br />Date Inspected _�,�i�?�� � _ <br />NO. Zo127 <br />