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everett CHART NO. <br /> e I <br /> City of Everett <br /> Sewer App1icat10r!a6_d"Perm1t <br /> NO. �7m DATE � � � � <br /> e-- <br /> Service Address 103 Utility Account No. <br /> BillingAddress <br /> City, State, ZipPermit Fee $ —_30— <br /> Owner ---1100011ercn Ramer _ Cnnnection charge <br /> Connection by --own—or L,c -T z- <br /> --- Trunk $ —tin�fff— <br /> Address Lateral <br /> ------ i otal Connection Charge $ <br /> Phone _646 3969____ _ __ Utility Development Fee <br /> Legal Description: Water <br /> $ •to n <br /> Lot __ <br /> '—'fit-22---�-— -- Sower $ <br /> Block Total Dw elopniont Fee $ <br /> Plat <br /> —R�a9�n'aoa-Ybxzaco ------- <br /> Unplatted Description: —_ — Sewer Bond District <br /> --- --_ Abutting Lot Line <br /> -- -- <br /> N, S, F. W <br /> Type of Permit tier ca>Jaeot�na—_._ Approved By <br /> Remarks _ Issued By <br /> -- --- Customer Signature <br /> IMPORTANT; <br /> CALL 1-800-424-5555 10-HOURS <br /> PRIOR TO DIGGING <br /> CALL 259-8810 FOR INSPECTION Inspection By <br /> Date Inspected _ 9� <br /> SEE SKETCH ATTACHED No. ?7944 <br />