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CHART NO. -- <br /> everett <br /> se,�f lei 11-%M/0111 <br /> City of Everett . <br /> Sewer Application and Permit <br /> NO. ?7 9r, 7 DATE <br /> Service Address lir _ c,.t n. BE Utility Account No. <br /> Billing Address 10204 Datlmll way Sur <br /> — <br /> City, State, ZipM— l;01, WA 9801 — Permit Fee $ 20.00 <br /> Owner Le..Iey Connection Charge <br /> C mnection by _ � �r�bP r.4 ne P e3 Trunk $ 11n nn <br /> Address Lateral $ <br /> Total Connection Charge $_ 110.00 <br /> Phone 481 886u_ Utility Development Fee <br /> Legal Description: Water $ 179 00 <br /> Lot 24 Sewer $ 471—Go <br /> Block Total Development Fee $ <br /> Plat a •..CeY d TYrrar. ply j _ <br /> Unplatted Description: Sewer Bond District <br /> Abutting Lot Line <br /> N, S, E, W ft. <br /> Type of Permit MW Donnas bis I Approved By <br /> Remarks _. Issued By <br /> Customer Signature <br /> IMPORTANTI <br /> CALL 1-800-424-5555 48-HOURS <br /> PRIOR TO DIGGING <br /> CALL 259-8810 FOR INSPECTION Inspection By <br /> Date Inspected <br /> SEE SKETCH ATTACHED NO. 27967 <br /> INSPECTION <br />