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� <br /> I <br /> � <br /> I <br /> CNART NO. — <br /> everett <br /> SeH-l- �o �as/,'� 4-t�.cu <br /> - :. r <br /> � City oi Everett _ <br /> Sewer application and Perr�it� . <br /> _ � � = <br /> z � <br /> s_ .., z <br /> t�lO. �8:3 n,r) DATE —�,..,. i, �o9i <br /> Service Address �30 - 110th Pl SE _ Utllity Account No. ------- <br /> BIIIing Address ��� -- <br />, City,State,Zlp �t• r�. 98200 Permit Fee $ __ __�p�p <br /> Owner __�.g,,� — Connection Charge I <br /> Connectlon by _ Trunk $ — <br /> Address uo�ax ++ � Lateral $ <br /> __— Total Connection Cherae $ -o- <br /> Phone _ _��__ Utilily Development Fee <br /> I.egal Description: Wat3r $ _ <br /> Lot -- Sewer S <br /> Block Total Development Fee $ -�- <br /> Plat — <br /> Unpleited Descriptlon: _ _. _ Sewer Bond District <br /> _ Abutting Lot Line <br /> ___ N, S, E, W R• <br /> Type oi Perml� �y��i �na�ation — Approved By .__ _ <br /> Remarks Issued By____ aaa gar���tct�ob <br /> _ Customer SlgnaWre _ <br /> IMPORTANTI <br /> CALL 1-500-424-55;5 48-HOURS <br /> PRIOR TO DIGGING /� � � - l <br /> CALL 259-8810 FOR INSPECTION Inspection By(_��� � � <br /> Date Inspocind — �/� /�/ <br /> SEE SKETCH ATTACHED No. 28305 <br /> IiNsi�rcrioN <br /> � <br /> i <br /> i <br /> I <br />