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■ <br />everett <br />Clty of Everett <br />i�i .... .. II �j_c�� <br />Sewer Applic;ation and Permit <br />N0. 2 8 314 DATE r.,,,e , ��yl <br />Service Address +_,�;�� �E s� Utility Account No. <br />I Bllling Address ---t�y enu <br />City, State, Zip <br />t er <br />Ownei _ <br />Feirmout Ilomes <br />Connecti�n by <br />Addrass <br />Phono <br />Legal Description: <br />Lot <br />Block _ <br />Plat i� r�.�� vt ea <br />Unplatted Descrlptlon: _ <br />Type of Peimit <br />Remarks _ <br />IMPaRTANTI <br />CALL 1-800-424-5555 48-HO!IRS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />CHART N0. <br />'i('6t�f � �VS!'ir(.y <br />� �kl-4� � <br />Permit Fee $ _ �o 00 <br />Connection Charge <br />Trunk � <br />Lateral q <br />Total Connectlon Charge $ �7U.0o <br />UtilityDevelopmeniFee i,;, ��:���1 u:v'vm iK.K�rill','�r;; . <br />Water t <br />f;[nur�^,-, � <br />SRWBf �1i111�' 11(iS.(MI <br />iP.K:lc � •'•i <br />Total Development Fea `� ��a' _ + ;iLNxo_oo <br />!'dN?I I I / �;II.IKI <br />1 I'i 1 'i 1 ;`�II.�� <br />f HI"1:1: } I I7 � 1 1 <br />Sewer Bond District bon� III <br />Abutting Lot Line <br />N, S, E, W ___ n <br />Approved By <br />Issued By _ � � <br />, <br />Cust . ,�• r Slgnature,� � <br />�; <br />I <br />; <br />7 <br />Inspection By _ � � � ��_ <br />Date Inspected _ �/ /Y�i/ <br />INSP[CTION <br />No. 2R314 <br />