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CHART NO. <br /> everett <br /> t <br /> ayrn <br /> City of Everett r <br /> It "It Sewer Application and Permit <br /> yH <br /> y z� <br /> o yd NO. 27962 DATE <br /> 0 o i Service Address 2 9mi 61; Utility Account No. — <br /> Billing Address —18201 Bothell% in <br /> C H City,State,Zip VIA Permit Fee $ 00 <br /> A d f/7 <br /> L <br /> ' Owner —___ ---- Connection Charge <br /> y ow Connection by g%j!je r�..��e- .________ Trunk $ >>.0 00 <br /> Address ----- -.---- Lateral $ <br /> Total Connection Charge $_-1'a o0 <br /> Phone Utility Development Fee <br /> I� Legal Description: Water $ V;9 sea <br /> "C Lot _ ++ ___ — — Sewer $ lb] 00 <br /> I_'Ww' Block — Total Development Fee $X50.00 <br /> Plat Aidanweod.7Y.rrnci�in_� <br /> Unplatted Description: _ Sewer Bond District --a <br /> Abutting Lot Line <br /> N. S,E.W _ n <br /> Type of Permit --tlercoction --- Approved By _ <br /> 1�1�1 Remarks —_— _ Issued By <br /> Customer Signature <br /> I� IMPORTANTI <br /> CALL 1-800-424-5555 48-HOURS / <br /> PRIOR TO DIGGING / <br /> :r„pection By <br /> CALL 259.8810 FOR INSPECTION <br /> Date Inspected — <br /> SEE SKETCH ATTACHED NO. 27962 <br /> IIdSPLCTION <br />