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CHART N0. <br /> T^ POSTING_ <br /> CIMe-rM M . i M () � <br /> ( r M M <br /> Sewer Application andPermi <br /> 2 <br /> 071, 5 DATE 5-16-04 <br /> Service Address 2628 58th St SI' Utility Account No. <br /> Billing Address 14410 Bel Ked Rd 0200 _ <br /> City, State, Zip Bellevue WA 98007 permit Fee $ 70.00 <br /> Owner Countrywood Bomee Connection Charge <br /> Connection by Owner % y e'l' '-o Trunk $ <br /> Address — Lateral $ <br /> Total Connection Charge $ - <br /> Phone Utility Development Fee <br /> Legal Description: Water $ 224.00 <br /> Lot 19 of Powder Mill Ilighlandn Sewer $ ~ <br /> Block Total Development Fee $ <br /> Plat <br /> Unplatted Description: Sewer Bond District <br /> Abutting Lot Line <br /> N. S, E, W ft. <br /> Typo of Permit new connection Approved By <br /> Remarks Issued By 'Iil <br /> Customer Signature <br /> , <br /> IMPORTANTI <br /> CALL 1-800-424-5555 48-HOURS <br /> PRIOR TO DIGGING / <br /> CALL 259-8810 FOR INSPECTION Inspection By <br /> Date Inspected <br /> SEE SKETCH ATTACHED <br /> INSPECTION 2974F <br />