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Everett <br />�e� <br />City of Everett <br />Sewer Application and Permit <br />NO. 27940 DATE yuyun <br />Service Address 1399 A&B fi3rd Ge Ft, Billing Address 17407 M,ikf1tPn Spoedway <br />City, State, Zip 1=nunnd L 9AM7 <br />Owner _ Sterling lions XW Inc <br />Connection by <br />Address <br />Phone <br />Legal Description: <br />Lot <br />Block <br />CHART NO. -- <br />Utility Account No. — <br />Permit Fee $ .A <br />Connection Charge <br />Trunk <br />Lateral <br />Total Connection Charge <br />Utility Development Fee <br />Water <br />Sewer <br />Total Development Fee <br />Plat Beverly hills Addn <br />Unplatted Description: __ Sewer Bond District _ <br />Type of Permit <br />Remarks _ <br />IMPORTANT! <br />CALL 1-800.424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259.8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Abutting Lot Line <br />N, S. E, W — <br />Approved By <br />Issued By <br />Customer Signature <br />n 2�OSi'�NO� <br />g- 1-91 J <br />$ t n2 7n <br />$ 457.10 <br />$ 559.30 <br />Inspection By <br />Date Inspected <br />INSPECTION <br />NO. 279.1Q <br />ft. <br />