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, <br /> E <br /> CHART NO. <br /> everett <br /> c eCA <br /> K s Sis R s s IS s s TO POSTING, 3 za <br /> o y o City of Everett Q c s �;. P o _ 4.t <br /> m z � Sewer Application rm' <br /> OH <br /> 0 g NO. 28396 LD3991 <br /> H <br /> HService Address Utility Account No. — <br /> w <br /> Billing Address m <br /> City.State,Zip ---IV-- tJ1 98203 Permit Fee $ _ <br /> 1'3 O C4 Owner Connection Charge <br /> Select L'omes <br /> Connection by -- Trunk $ <br /> Address — Lateral $ <br /> Total Connection Charge $ <br /> Phone Utility Development Fee <br /> Legal Description: Water $ <br /> CLot Sewer $ <br /> 14 <br /> I Block _ Total Devi-l:pment Fee $ <br /> L:3 Plat -star <br /> Unplatted Description: _ Sewer Bon :1 stri t _ � }-- <br /> Abutting Lot Line <br /> NSEW h. <br /> Type of Permito Approved By— — <br /> nect on <br /> Issued 8 <br /> Remarks Y --�--- <br /> Customer Signature <br /> i 1� <br /> J= IMPORTANTI <br /> �� CALL 1-800-424-5555 48-HOURS <br /> PRIOR TO DIGGING <br /> inspection By <br /> CALL 259.8810 FOR INSPECTION <br /> Date Inspected <br /> SEE SKETCH ATTACHED NO. 28396 <br /> INSPEC11ON <br /> a <br />