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everett <br />City ot Everett <br />Sewer� Applica <br />No. 28244 <br />= A �$8:: <br />- � -�;__ <br />tion and Qecmit� <br />'_1 `=�R==-�' <br />,�,_�' <br />DATE ►�9 2 ; i9g7 �' - — = <br />CNART NO. <br />Scii� fz �o��, � <br />��z 3�q l <br />SeM1lce Address �6 ll��h oi sn Utllity Account No. _ <br />Billing Address 21902 32th 7�w M <br />City, State, Zfp Bri�r WA 980]G Permit Fee $ ��_�� <br />Owner _ �,i..Mc n�s <br />Connection by <br />Address <br />Phone <br />Legal Description: <br />Lot � <br />Block <br />Plat . Maridien Placa <br />UnplatleC Description: <br />Connection Charge <br />Trunk <br />Lateral <br />$ <br />. �� <br />Total Connection Chargr; $ 7�0.00 <br />Utili(y Developrnent Fee <br />Water <br />Sewer <br />Total Development Fee <br />$ v�_nn <br />$ 471.00 <br />� 650.00 <br />S3wer Bon�f District BonA 2II <br />Abutifng Lot Line <br />N, S, E, W <br />ft. <br />Type of Fermit taer Connect.ian Approved By _ <br />Remarks Issued By �..t�..+.r r�r�,.n <br />Customer Signatur�� <br />IMPORTANT! � <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Inspection By����.e� <br />�.�-- <br />Date Inspected _ <br />INSPCCTION <br />No.282a4 <br />