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� �H <br /> � 'j� CHART N0. — - <br /> y ��` � everett � <br /> re n <br /> PvxPv � <br /> H <br /> � <br /> � x -� -. - <br /> o� � City of Everett y ' „ ' - � � �-� 3 <br /> � �g ! - - �=TQ POSTING-__._...�- I <br /> �y� i �ewer Appli�ation a�d Per��r�it _ _ <br /> yy - ; �` :� � ; x <br /> g�v~i � NO. �H 7 � � DATE . o-a� -- _ — I <br /> ��� ' - --- - <br /> , <br /> Servia Address �ZS_i1Dcl�LLSE—_ Utility Account No. <br /> I Billinc�Add�sss _ nn R.,: on� <br /> I <br /> City,State,Zip �—��a•— Permit Fee $ �,� _ <br /> I Owner T-��T� N�Cy�ulwr ConnectionCharge , <br /> i <br /> Conneclion by p,m� Trunk $ ��,pg � <br /> i <br /> Address — Lateral $ <br /> i � <br /> I -- Total Connection Charge $ �an nT i <br /> � I <br /> , Phone �;a��o Ulility Development Fee <br /> � I Legal Descdption: Water $ �,o n� � <br /> i ; I Lot '+ ot sv •6-0� _ Sewer $ -471.,00— I <br /> � I Biock — Total Development Fee $ ysp pp � <br /> ' � Plat � <br /> � � Unplatted Description: Sewer Bond Disirict itt __ I <br /> 1 Aoutting Lot Line � <br /> ' _ _ N. S, E,W _ fl. <br /> � I <br /> �' i Type of Permit ner ronnec�iea Approved �y �� <br /> I � <br /> �' ; Remarks _yu��.��lg_u� ..__�_ Issued By M+ I <br /> 1 � c„�z�, Customer Signalure— — � <br /> ' i <br /> i IMPORTANT! i <br /> �� ; � <br /> � j CALL 1-B00-424-5555 48-HOURS _ <br /> i <br /> � PRIOR TO DIGGING !,i � � �—> � <br /> � �� / ��- __.. _-- <br /> I CALL 259-8810 FOR INSPECTION Inspecilon By - ' I <br /> Date Inspected _ _ —_� � <br /> li SEE SKETCH ATTACHED N0. 287CJZ <br /> I <br /> ,�� , , � <br />