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Sewer Applica <br />, <br />Service Address 2503 62nd st <br />r.i pp pp o <br />6 IA <br />M M M <br />fl <br />tion and POr 1�# <br />#coM0 � <br />DATE 3-16 4 <br />Billing Address 6424 Beverly Blvd <br />City, State, Zip Everett WA 98203 <br />Owner Ellen Weddle <br />Connectio, by <br />Address <br />Phone -- <br />Legal Description: <br />Lot <br />Block <br />Plat <br />Unplatted Description: <br />Type of Permit <br />Remarks <br />off <br />Utility Account No. <br />CHARTNO. <br />TO POSTI NG_ I - 2�5 <br />Permit Fee $ III. <br />Connection Charge <br />Trunk $ <br />Lateral $ <br />Total Connection Charge $ <br />Utility Development Fee <br />Water $ <br />Sewer $ <br />Total Development Fee $ <br />Sewer Bond District <br />Abutting Lot Line <br />N. S, E, W <br />Approved By <br />Issued By <br />Customer Signature <br />IMPORTANTI / rl <br />a 0 CALL 1-800-424-5555 48-HOURS //f <br />PRIOR TO DIGGING / 1 P �O <br />%'V O <br />CALL 259-8810 FOR INSPECTION Inspection By -- <br />i <br />Date Inspected <br />SEE SKETCH ATTACHED <br />INSPECTION <br />ft. <br />