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C <br /> CHART NO. <br /> everett <br /> TO POSTING- <br /> C:: <br /> OSTING. <br /> a�xyH City of Everett <br /> H Z3 <br /> Sewer Application and Permit <br /> y= <br /> Q N Q <br /> qzH NO. 28464 DATE at, 10, 1901 <br /> d f9- <br /> o Service Address --coth rl sn Utility Accoul' No. <br /> a. 0 Billing Address 217 r1m St <br /> t y 1 City, State,Zip _ Everett WA 90201 Permit Fee $ 10.00 _ <br /> 814 H Owner Select ROWS _ Connection Charge <br /> OCN <br /> r Connection by 0vnar 45 ,oL C� Exc.iv. Trunk $ — <br /> y p y Address Lateral $ — <br /> Total Connection Charge $_. <br /> Phone _ 250-1501 _ Utility Development Fee <br /> Legal Description: Water $ 179.00 <br /> Lot _�L of .nabroo niy 1 _ Sewer $-- <br /> Block Total Development Fee $ — 179'00 <br /> Plat — <br /> Unplatted Description: Sewer Bond District OLIN !1 j,4g101 <br /> ALulling Lot Line <br /> ' - - N. S. E.W <br /> 1 Type of Permit N... connection Approved By <br /> Remarks Issued By Hughes — <br /> 1 _ Customer Signature—_ <br /> IMPORTANT! <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 NO. ^G 846 Q <br /> INSPECTION <br />