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1 � '•^P('*� r.,.'F7,T..` 1 � .�.�j...yiN,l..i•Jt.' . .•.,.. <br /> *' i+ CHART NO. —_ <br /> q TO POSTING" <br /> r- rr r: <br /> Sewer Application and, , ((e� rm_ !�1■'((,}J1iy i <br /> 29187 3/af/ltlltt922e !2dCaa ', C) <br /> DATE <br /> Service Address 2614 57th St Sw Utility Account No. <br /> Billing Address _ 14410 Bel Red Rd <br /> City, State,Zip _Bellevue WA 98007 Permit Fee $ 70.00 <br /> i <br /> Owner ntxvson�L,7 --e — Connection Charge <br /> Connection by 'vel .> Trunk $ <br /> Address _ Lateral $ <br /> Total Connection Charge $ 0.00 <br /> Phone _ Utility Development Fee <br /> Legal Description: '16 Water $ 224.00 <br /> Lot i Sewer $ <br /> 224.00 <br /> Block Total Development Fee $ <br /> Plat FQg¢er M111 highlands — <br /> Unplatted Description: Sewer Bond District <br /> Abutting Lot Line <br /> N, S, E, W <br /> Type of Permit Nov connection Approved B <br /> — PP Y <br /> Remarks Issued By B <br /> Customer Signature <br /> IMPORTANTI <br /> CALL 1.800-424-5555 48-HCURS <br /> PRIOR TO DIGGING <br /> CALL 259.8810 FOR INSPECTION Inspection By <br /> Date Inspected ��"� �� 13 <br /> i SEE SKETCH ATTACHED <br /> INSPECTION " 29187 <br />