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t <br /> r <br /> p <br /> CHART NO. <br /> everett <br /> TO POSTING_ <br /> C,�H <br /> ra y CA Ee <br /> City of Everett 'R r- Ij S _ B <br /> 39 <br /> U0 Sewer Application and Permit. r <br /> Mz �, ' <br /> r7 NO. 2) 8 3 . S DATE a-is-4i <br /> OHC <br /> 0. Service Address a - bget ec ,.. _ Utility Account No. <br /> a y Billing Address 1'17 VIM at <br /> g y H City, State,Zip Oft— Permit Fee $ 30.00 _ <br /> n d rn <br /> Owner r-14-► uc r . Connection Charge <br /> tray y Connection by ownor!51*1otn. 62 Ex CCA v Trunk $_ <br /> Address Lateral $_ <br /> Total Connection Charge $ --- <br /> Phone _ Me 1SntJ Utility Development Fee <br /> Legal Description: Water $ 174 in <br /> Lot _ A f Panahrook My 3• Sewer $_ ---- <br /> .�' Block Total Development Fee $ 179-An <br /> Piat <br /> Unplatted Description: _ Sewer Bond District <br /> -- Abutting Lot Line <br /> N. S,E,W tt, <br /> Type of Permit _ !!ew i_cmn=uc=__ _ Approved By <br /> Remarks - _ - Issued By- M nn�... <br /> Customer Signature_ <br /> IMPORTANTI <br /> CALL 1-800-424-5555 48-IIOURS <br /> PRIOR TO DIGGING <br /> CALL 259.8810 FOR INSPECTION <br /> Inspection By - A � <br /> Date Inspected <br /> SEE SKETCH ATTACHED No. 2$395 <br /> INSPECTION <br />