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I <br /> µ CHART NO. --- ------ <br /> everett <br /> � ee <br /> TO P(1UMC,: <br /> aq 9� <br /> y moi, City of Everett T 8 8 8 8 b a <br /> K n I <br /> pyC O « 41 <br /> w <br /> to � Sewer application and Rq : t � . _ �� „ <br /> � y 1 [- � � <br /> � A 8 NO. 2 8 3 9 7 DATE — t-'7-9 <br /> Q. n <br /> H Service Address 122 60th PI SE _ Utility Account No. - <br /> > H <br /> rC H nilling Address 237 Elm St <br /> n C7 CA City, State, Zip rA Brett M1 98203 ___-_ .._ Permit Fee $ 30.00 <br /> y Owner Solect Homo Connection Charge <br /> q O �' owner SnoIn ec x Cny, Trunk $ <br /> Connection by — <br /> Address Lateral $ <br /> Total Connection Charge $ <br /> Phone 259-1503 Utility Development Fee <br /> Legal Description: Water $ 179 00 <br /> /C <br /> Lot 1_of 12nnhrook Sewer $ ---- <br /> Block _ _—.— _...- — Total Development Fee $ 179,01) <br /> 1 <br /> _1 Plat�j Unpinned Description: ---- Sewer Bond District _ 1114n41 (4900) <br /> Abutting Lot Line <br /> N, S, E,W <br /> Type o1 Permit new connection Approved By <br /> 1��I Remarks __ _— Issued By vRuqh90 <br /> Customer Signature— <br /> j `1j 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 AVTACHED NO. 28397 <br /> INSPECTION <br /> it <br />