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everett - <br />, ...,.,��,:� �(__��-�c :;: <br />x <br />y <br />T <br />S <br />City oi Everett � =. <br />� :. <br />` LV <br />Sewer Application and Perrx�i� �' <br />� ��� <br />N0. 2 8 2 4 5 DATE _ nw z, i4�i �' J�� <br />SBrvice AddreSS 18 113Lh pl 6R <br />Bllling Address 21902 3Bth A�e p <br />City, Stete, Zlp Sri�z fl� 9B0]6 <br />Owner !� Faiteont floare <br />Connectiun by 8+�'"s <br />Address <br />Phone <br />Legal Deacriptlon: <br />Lot _ <br />Block <br />Plat _ � <br />Unplatted Oescription: <br />Metid�wn Place <br />Uliiity Account No <br />Permit Fee $ <br />Connection Charge <br />Trunk <br />Leteral <br />CHART N0. <br />30.00 <br />$ _ +�n ne <br />$ <br />TntalConnectlon Charge $ 330.00 <br />Utllity Development Fee <br />Water g 179.00 <br />Sewer <br />Total Development Fee <br />Sewer Bond Disir(ct <br />Abutting Lot l'�e <br />N, S, E, W <br />$ _ 171.00 <br />$ 650.00 <br />Bona siI <br />Type ol Petmlt _ x�r oona�ctim Appro��ed By <br />Remarka _ Issued B �.,,.__. <br />y ..:..�ac <br />. '�..�^^�..— <br />: � :,..�- . . -.. <br />— CustomerSignature' <br />IMPORTANT! �� <br />CALl.1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259•8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Inspection By � �, <br />Date Inspected � � � <br />ir�sr�rcriora <br />No. 28245 <br />n. <br />