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T'rT..,_•ry,ir_.""""T_;�,; " .'T�''-•r:-'; j•��Ai <br />•.ir, � , �`�: - .. <br />•�� <br />` I�%% - , <br />Sewer Application and Permit <br />'' 9 � ��'� DATE lo-zz-9� <br />ServiceAddress �600 121ec st SF. /3��q / <br />BIIIingAddress 6510 Southcencer Rlvd <br />City, State, Zip Tukwiln WA 9P18A <br />OWf1Ef SchnelJer Nomer. (Cnapor Ccnek) <br />Connection by <br />Address � <br />Phone <br />Legal Description: <br />Lot <br />Block <br />Plat <br />Unplatted Descrlplion: <br />Type ol Permll �Pv connectinn <br />Remarks <br />IMPORTANT! <br />CALL 1-600-424-5555 48-HOJRS <br />PRIOR TO DIGGING <br />CALL'159-8810 FOR INSPECTION <br />Utility Account No. <br />CHART NO <br />TO FOSTING�Z s-q� <br />Permit Fee $ _ '�� •'_��� __ <br />Connectlon Chargo <br />Trunk $ 3449.�•�� <br />La'era� $ --- <br />Total Connection Charge $. J449. 6n _ <br />Utility Develo�,ment Fee <br />Water $ 5917.'�h <br />Sewer $ 15'S8. �'' <br />Tota� Development Fee $ _� '-�" � <br />Sewer Bond District — ' � ' .— <br />Abutling Lot Line <br />N, S, E, W '�' _ ft. <br />Approved By <br />Issued By ��� _ <br />Customer Signature _ <br />, <br />Inspection By( /��j� �:� <br />Date Inspectod � �� �� <br />SEE SKETCH ATTACHED <br />INSPECTION � � a ] •", <br />