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everett <br />City of Everett <br />Sewer Ap�i <br />CHART N0. — _ <br />S en�- :b �os�, �y �-i�, �r� <br />`K <br />y <br />M <br />F `�'�- q�, � <br />• :: q �; � �: <br />- , <br />icativn �nd P�'r�i � M.,:� <br />Ci �] ' <br />�� �W 3�[•4: <br />��' �i� o <br />N0. 2�� H 3 DATE ru 2 � _ <br />Service Address _I�- �13i* Qr � �_ <br />BIIIing Addrec� —���'22 ' ]8th Av� _ K. <br />City, State, Zlp _�[t.rr, rt► geo�b __ <br />Owner _ Ialsacieti �nr�s <br />Connec;lon by _. gM��� <br />� P�d�ess _ <br />Pnone l56-21�5 <br />Legal Description: <br />Lot 23 <br />81ock __--__ <br />Plaf r..+��.� et _ <br />Unplatted Descripi(cn: _ <br />Tyr� ;I Permit __p� �_-- <br />Rerrarks ._.____ <br />IMi�ORTAN71 <br />CALL 1-800-424-5555 48•I10�JRS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Utility Account iJo. <br />Pe-mitFee $ 30.00 <br />Connection Charge <br />Trunk <br />Lalera: <br />To�el Conn,�c��on Charge <br />Utllity Devolopmrnt Fee <br />Water <br />Sewer <br />Total Development Fee <br />$ �]0.00 <br />$ <br />$ 330.00 <br />$ 179.00 - <br />a 471.00 __ <br />$ 65D.00 ----.._ <br />Sewer f3ond Disirici _�a ��_ ___ <br />Abutling Lot Lino <br />N, S, E, W _ <br />Approved By <br />Issued 8y __�LAac1otl411__ <br />Customer �ignature �,, .:.------ — <br />,I, <br />-- n. <br />, <br />Inspt+ction By 1/l ��-.�/ �4�'=1..-2. �/--�! <br />Date Inepected _____. � � <br />�rds��r_�; ��iori <br />No. 2R2B3 <br />