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xH O H <br />aH <br />a0zx <br />C H <br />TO P;1STI'G_ 0143 <br />Server Application and Permit <br />_' ? 0 W DATE '-1-93 <br />Service Address <br />10912 7th Ave Sr <br />Billing Address <br />gIIII1e <br />City, State, Zip <br />Everett 14A 98208 <br />Owner <br />Massoud Vaziri <br />Connection by <br />Address <br />Phoi.e 353-8775 <br />Legal Description: <br />i 0! <br />Block <br />Plat <br />Unplatted Description: <br />Type of Permit New Connection <br />Remarks Fork must commence on thin permit <br />within 60 days of ieauance. <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 />utility Account No. <br />CHART NO. <br />07if11.!93 I I I A'M 000AN77% <br />400029057 <br />SEWER $10.00 <br />DECK Via. Go <br />Permit Fee $ 30.00 <br />Connection Charge <br />Trunk $ <br />Lateral $ <br />Total Cornection Charge $ <br />Utility Development Fee <br />Water $ <br />Sewer $ <br />Total Development Fee $ <br />Sewer Bond District <br />Abutting Lot Line <br />N, S. E. W <br />Approved By <br />Issued By <br />Customer Signature _ <br />LID 730 <br />i <br />Inspection qy51—� <br />C � <br />Date Inspected <br />INSPECTION <br />25. 57 <br />ft. <br />