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everett CHART NO. <br /> e C <br /> TO P!!7I�'r <br /> City of Everett § 8 $ 5 8 888 <br /> Sewer Application an j Permit_ 1 - <br /> NO. 28597 DATE Feb 4, 992 y <br /> Service Address 6 - both P.1 Sr Utility Account No. <br /> Billing Address I 4!1^11_`-1+ eac _ <br /> City, Stale, Zip — ^}wI auo 1'A 99�C12 Permit Fee $ 30.00 <br /> Owner ---iia rmlKoak 1"C Connection Charge <br /> Connection by Trunk $ <br /> Address _— Lateral $ <br /> Total Connection Charge $ <br /> Phone Utility Development Fee <br /> Legal Description: Water $ 179.60 <br /> Lot ___ 3 Sewer $ <br /> Block _ _ —_ Total Development Fee $ 179_n^ <br /> Plat <br /> Unplatted Description: Sewer Bond District ULIll <br /> Abutting Lot Line <br /> - <br /> N. S, E,W ft. <br /> Type of Permit µ_eseaePC1P -- - Approved By <br /> Remarks - Issued By <br /> ---- Customer Signature <br /> IMPORTANTI <br /> CALL 1-6'10-424-5555 48-HOURS <br /> PRIOR TO DIGGING <br /> CALL 259.8810 FOR INSPECTION Inspection By (•� ��i� — <br /> Date Inspected <br /> SEE SKETCH ATTACHED NO. 28597 <br /> INSPECTION <br />