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eve� ett <br />Cfty oi Everett <br />�i,i ', _ :..`':� �(�t'�_� t, <br />�ewer Application and Permit <br />NO. ZH�?% DATE .+�r>> sz »vi <br />Service Address ����SL. 6t Utiliry Accaunt No. <br />BfII��gAddress �}q�3 3bli� �4�er it <br />City, State, Zip �_„tle36 <br />�yy(�gf 9�1r�mnt Iinm!■ <br />Connection by _ <br />Address _ <br />Phone _ <br />Legal Description: <br />Lol <br />Block <br />Plat <br />Unpladed Descriptlon: <br />Type of Permit <br />Remarks _ _ <br />IMPORTANTI <br />CALL 1-B00-424-5555 48-HOURS <br />PRlOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />SEC: SKETCH ATTACHED <br />Permit Fee <br />Connection Charge <br />Trunk $ _�_ <br />Lateral <br />1�� 2�:$ �.• , ..n.. �,.:� <br />Totel Co���ection Charg� $� 37U OU <br />,tOq(k'd:..3 <br />Utflity Development Fee ��� � ��•�� <br />fiN)III f ;70.OD <br />W8�01 � l�i �$�i }u� �L� <br />GlI01YR�L� 71 iio-- <br />Sewer Ih1TF� �i�i8y- <br />Total Jnvelopment Fee ��p� Y���� v <br />,,Cu<� <br />lqIi11U t'.?O.�lil <br />l 1'71 5 fi� `.'�1.1 Ml <br />Sewer Bond Distdct _ !uK1ib'�l�i��, <br />14NCk �IY:�.�Ai <br />Abutting Lot Line 91bu�'?a2:5 <br />';�.6N:I� i� ;D.�il� <br />N, s, E, w �� w, � i �.,, �y, _ n. <br />ApprovedBy �i;t-1 t.F';O.�Ni <br />---:»ki'iN,.'f�ff <br />Issued By tNill l' � U��{(-q <br />,,,.� <br />Customer3lgnature_ '��-�� "'��•�� _ <br />I,111� � � � t' tU.f1Li <br />� It:l...- ►i�S�.�l[1 <br />lili�)UII �;' 111 <br />bh��TI�P t10•,,tMi <br />� 1'FN�I}, l�iJr�1.LK� <br />Inspection By <br />Date Inspected ��� <br />i'JSI'LCTIO�J <br />No. 28227 <br />