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everett <br />Clty of Eve • :t <br />IIJ r ' �� xe (, <br />i��.i.: , . .' I I���--`1�_ <br />'$� � <br />� �' Q�'� <br />Sewer Application and Pei�i��t .. . <br />NO. 2$243 <br />_ z�_{;�=— <br />_ _.k �� <br />^ • i _ <br />DATE r ay z, 1991 �' <br />Servlce Address __ � li+i* P� gs <br />Bllling Address ++�a�� ��� N <br />City, State, Zip <br />01N�9f _ l��aet n....� <br />Connecllon by _ <br />Address <br />Phone <br />Legal Descriptlon: <br />Lot <br />Block <br />Plat <br />Unplatted Desoription: <br />Type of Permit <br />Remarks _ <br />IMPORTANTt <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />SEE SKETCH A7TACHED <br />Utility Account No. <br />Permit Fee $ _ �� o� <br />Connection Charge <br />Trunk <br />Lateral <br />$ a±o.00 <br />$ <br />Total Connection Charge $ _����AO <br />Utility Development Fde <br />Water <br />Sewer <br />Total Development Fee <br />Sewer Bond DisVict <br />Abuttfng Lot Llne <br />N, S, E, W <br />Appraved By <br />$ _ i�9 00 <br />$ <br />S _ eso.00 <br />n. <br />Issued By aed <br />Customer Signature ��' ,�`=r �� ^ <br />� <br />,, <br />� <br />Inspection By / � � ��'' _ <br />Date Inspected __� <br />INSPGCTION <br />No. 28243 <br />