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I <br /> H M CHART NO. ---- <br /> b <br /> iol <br /> everett <br /> v t¢ <br /> Ogg pppp ��11 TO POSTING <br /> N N If� .7 031� � <br /> City of Everett <br /> Sewer Application and Permit <br /> H NO. 28689 <br /> -DATE -17.__1��2 -- <br /> IE - <br /> Utility Account No. <br /> y Service Address <br /> Billing Address a0 00 <br /> Permit Fee � <br /> City,State,Zip <br /> Connection Charge <br /> Owner Cour ' ff <br /> I �a j: , �nolclnc.'_ Trunk $ <br /> Connection by $ <br /> Lateral <br /> Address <br /> Total Connection Charge $ <br /> Utility Development Fee <br /> Phone 64, $ =24.00 <br /> ��• <br /> Legal Description: Water $ <br /> _ Sewer <br /> 1 Lot' 224 00 Total Development Fee $ <br /> J1 Block <br /> Plat 1 '111 in <br /> Sewer Bond District <br /> Unplatted Description: <br /> Abutting Lot Line <br /> n. <br /> _ <br /> N.S. E,W <br /> low�1� Approved By <br /> Type of Permit <br /> _ issued By J <br /> � Remarks _— �— <br /> � Customer Signature <br /> IMPORTANTI <br /> RUM <br /> 1 CALL 1-800.424-5555 48-HOURS <br /> PRIOR TO DIGGINGS �mwN <br /> tn�pedion By <br /> CALL 259-8810 FOR INSPECTION Date Inspected '' v <br /> NO. 28689 <br /> SEE SKETCH ATTACHED <br /> IT INSPECTION <br />