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everett <br />City of Everett <br />Sewer Applicat <br />No. 28285 <br />,; <br />=_ <br />: �: k�"�: <br />s <br />• Y `� ,_ <br />• , N T il ��• •-� <br />ion a�c� �� r,.�i't <br />-,� ;��.•,�v�=� <br />DP.TE r.y zl. 1991 � <br />S6NICB /�d(Jf9SS _ 23 -! 1 4f1. e� e. <br />BillingAddress �l°^� — +�•� � m <br />Clty, State, Zlp e►�.. ra onr,3R <br />Owner __ raimmt �... <br />Connectlon by cr�.�. <br />Phone iSB-�114 <br />Legal Descriptfon: <br />14rid �n Pl <br />Unplatted Description: <br />Type of Permit � `���� <br />IMPORTANTI <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259•8810 FOR INSPECTION <br />Utility Account No. <br />� �� <br />Connectian Charge <br />Total Connection Charge <br />Utilfty Development Fee <br />1'otal Development Fee <br />Sewer Bond Disirict <br />Abutting Lot Line <br />Issued By J mcw.,.] 1 <br />� . <br />Customer Slgnature �_ <br />� <br />�, <br />� as�, Ko� <br />? —/ f� -91 <br />$ �]0.00 <br />$ 179.00 <br />q �71.00 <br />$ 650.00 <br />Inspectlon By �/ �" �" � " , <br />Date Inspected _�� <br />S�E SKETCH ATT�CHED NO. Z$Z8`J <br />