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everett <br />�r <br />� <br />City oi Everett r - 4 ' - - `` '" � 4 - - 4 <br />- _: _ :; - ,? ; ; � _; +' _ = <br />Sewer Appl�c��itibn_��d�Per it { , <br />�: ;: -� � ��; __._,��...= . <br />,�r��;:. �=��s- ^� �-- <br />t ..:i�,,,��;"�:�;;`=:��'=��`-'� <br />NO. ZH333- �� DATE -� ' <br />CHART N0. <br />Service Address �- y��h g� B$ <br />Bflling Address 2190� - +erti .e. .. <br />Clty, State, Zip ��+.. _� yQ096 <br />fhvner - ..�....._. Q._�� <br />Connection by �; <br />Address <br />Phone 356-2�u <br />Legal Descrfptlon: <br />Lot _ �c <br />Block <br />P�81 Y�rfAfan Ol <br />Unplatled Descriptlon: <br />Type ol Permit _������ <br />Remarks _ <br />IMPORTANTI <br />CALL 1-800-424-5555 48-HOURS <br />PRIOP TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />SEE SKETCH ATI'ACHED <br />Utility Account No. <br />Permit Fee $ <br />Connectlon Charge <br />Trunk <br />Lateral <br />......,,,� 1_ _� <br />; .,�,li,u_ <br />$ a3n_nn <br />:� <br />Totel Connectlon Charge $ __��n np <br />Utility Development Fee <br />Water <br />Sewer <br />Total Development Fee <br />Sewer Bond District III <br />Abutt(ng Lot Line <br />N, S, E, W <br />Approved By <br />$ _ 471.00 <br />a 6se_nn <br />Issued By _ � no.�t..�aL_ <br />/ , -!' <br />Customer Signatu/e ' <br />1 <br />�, <br />� <br />Inspectlon B�,e �_ <br />Datelnspected �, —���% <br />'� <br />wsi�Ecr�ora <br />No. 28333 <br />