Laserfiche WebLink
everett <br />Clty of Everett <br />CHART N0. <br />10 �'i��ll�?`� �_�'�� ��— <br />T <br />T �G �Y J� <br />"4 �� .1 � � .�'_. <br />- , <br />Se�er Application ar+d Per��t, � , � " <br />J 1 <br />i1 - <br />, i'. � � .��1l� -y ��. y� <br />y� :: '� -s � � „ 1 <br />NO. 2$ c� 4 6 DATE �q 2.�•e91- <br />Service Address 17 113*' "' Ba <br />- Utility Account tJo. <br />BIIIIngAddre�s ?1903 .. _ _Aw W _. <br />City, State, 7.Ip _ Brier MA 98036 <br />Owner r.� r.mc nn.i.. <br />l:onnection by g�� <br />Address <br />Phone _ <br />Legal Descriptfon: <br />Lot <br />Biock <br />M�rldi�n Plee� <br />Plat <br />Unplatted Desc�Iption: <br />Type ol Permit Nw cw�n�ct.ia� <br />Remarks <br />IMPORTANTI <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPC•CTION <br />5EE SKETCH ATT'ACi1ED <br />Permit Fee $ <br />Conner,tion Charge <br />Tr�nk <br />Lateral <br />Total Connection Charge <br />Utllity Development Fee <br />Water <br />Sewer <br />Total Development Foe <br />30.00 <br />$ ]30.00 <br />� <br />$ 7�0.00 <br />$ 179.00 <br />$ Ia3�— <br />$ 650.00 <br />Sewer Bond Disirict eand III <br />Abutting Lot Line <br />N, S, E, W n• <br />AFproved By _ — <br />Is;ued By—� *ie ��d <br />� ,�__. <br />'Justomer Slgnature �� <br />� � <br />� <br />InspectfonBy� �� �� � ���_ <br />i <br />Date Inspected �� 3/� <br />INSf'GCT'ON <br />No. 28246 <br />