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everett <br />City of Everett <br />„ �;ii',G_�� ��-`,, <br />{,a . — — <br />Sewer Appli�cation and Permit <br />No. 2 8 2 2 4 ua•rE —„��--�a,�.,�--- <br />Service Address — 6— 113th Pl &� <br />Bllling Address ��'t— <br />Olty, Slate, Zlp —���„�� ib— <br />Owner -- <br />Connection by _ — <br />Ad�ress <br />Phune . +s� ��+� <br />Legal Descriptlon: <br />Lot _ <br />Block <br />PIeI _ ''" �' ��° <br />Unplaqed Descrlptlon: _ <br />Type ol Permi: <br />Remarks _.�ewwwtl�en <br />IMPORTANTI <br />CALL 1-800-4Y4-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Iitility Account No. <br />Permil Fee <br />Connection Charge <br />Trunk $ '� "" <br />n.,�, ol 1.-:�.:"I�w iXx1�iN,;.�rY; ,.,,, <br />Latsral $, <br />lN�l '�; r� <br />Total ConnecNon Charg�� ��,� " <br />UtilityDevelopmentFee ���'��� �''�'�„� <br />11't+ 5 ir'„(l,r!) <br />WalOf !;Itln.�','ll° .,��,p0 <br />ik1IFF' i 10'i.(ai <br />Sewer Hix��! " <br />'ahNE.' i'A.f10 <br />Total Development Fee � }A, �S , , _ <br />f 171 � :.`'AL [M] <br />q(YIIN�';;il; <br />Sewer Bond District — �'h„� � " 1 ��� <br />iNJ� u.� � t, ;.'.�, <br />Abutting Lot Line `�I.4N.L: E ui.lxi <br />1'Iq!111 i:;t(i,iYi <br />N� S, E� W � r�, .�, ae« �vi tt. <br />IIlX11bY7: ti W <br />Approved By . <br />;AM�q;.ti;. <br />Issued By . , <br />CustomerSignature ��t�I zt:t0.fn <br />1 I'� I '> 4h50.�A <br />;Knu�r,i�o <br />i�w�trF� �i�r,.iri <br />�'Idi,l. '..i4nil.fql <br />� B <br />Inspection By ' <br />Dete Inspected <br />W�^E]CiION <br />No.28224 <br />