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1 <br /> .. CHART NO. <br /> � everett <br /> m OWING, <br /> oo H 81S <br /> y City of Everett s g <br /> Sewer Application and Permit r � . <br /> C „ R <br /> 8 m No. 2 8 4 x 5 DATE Oct. 7 1991 _ <br /> () O N <br /> EService Address 10eRnth 21 -SE _ Utility Accou, t No. <br /> N <br /> Billing Address E. 4020 Nair, -- <br /> City,State,Zip SpokABA W1 00201 - -- Permit Fee $ 30.00 <br /> OwnertIo 1 I Connection Charge <br /> Connection by CI '-CN"` �`" kt"�� Trunk $ <br /> Address —_ Lateral $ <br /> Total Connection Charge $ <br /> Phone (509) 534-0644 Utility Development Fee <br /> 1.'C <br /> Legal Description: Water $ 17q.00 <br /> Lot Sewer $ <br /> Block Total Development Fee $179.0p <br /> Plat <br /> Unplatted Description: _ _ Sewer Bond District <br /> loft Abutting Lot Line <br /> N,S. E,W n <br /> Type of Permit g4Connection-- Approved By <br /> Remarks _ Issued By N amh'a <br /> -- <br /> _1J Customer Signature <br /> 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. 28445 <br /> INSPECTION <br />