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everett <br />City of Everett . � <br />Sewer Application and P�rmit <br />NO. �� i'l �i DATE _ s,u,n_b.1991---- <br />ServiceAddiess —a;,_;}3�p_�,}..�___-__--_---- <br />Billing Address » nm=�p�, aow m_ _ <br />City, State, Zip _ y=i�. tan--980�� _ <br />Owner Fairnont Itomoe <br />Connection by Umer <br />Address _ <br />Phone �SG-2t15 <br />Legal Description: <br />Lot �q <br />B'ock — <br />f'lat �7�ridt�a Dlao� <br />Unplatted Descrip�ion: <br />Type of Permit _���: <br />Remarks _ ____ -- <br />IMPORTANTI <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Utility Account No. <br />CHART N0. <br />POSTING Ap�t i l zoo6 <br />Permit Fee $ _ 70.0� _ <br />Connection Charge <br />Trunk $ 3�o_oe <br />Lateral $ <br />Total Connection Charge $ 330.�0 <br />Utiliry Development Fee <br />Water $ _ t �o np <br />Sewer $ ��� <br />Total Development Fee $ �x50.00 _ <br />Sewer Bond Disirict _Ii�ns�_1II--- <br />Abutting Loi Line <br />N, S, E, W -- - - ft. <br />Approved By _ <br />Issued By— a 3�eeRwsi} <br />Customer Signature <br />i' <br />Inspection By l / �� ' _ <br />Date Inspected ��� � . <br />No. 28309 <br />� <br />