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evere►t <br />City of Everett. <br />rJP P <br />� 0- <br />Sewer Application and Permit <br />No. 27938 DATE <br />Service Address --4341 an 9—.— <br />Billing Address --t7,ie7 jukiSpeedway <br />City, State, Lip <br />Owner _ <br />Connection by <br />Address <br />Phone 742-6544 <br />Legal Description: <br />Lot--Se"theehe�3--(Iota sP-at33-&93---- <br />Block <br />Plat <br />Unplatted Description: <br />Type of Permit—ttexYonrtection <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 />Utility Account No. <br />Permit Fee $ <br />Connection Charge <br />Trunk <br />CHART NO. <br />60 t705i . <br />4-i-9t <br />Lateral <br />Total Connection Charge <br />Utility Development Fee <br />Water <br />Sewer <br />Total Development Fee <br />$ 102.20 <br />$ •—: !7 a- <br />$. 559.30 <br />$ 261.96 <br />$ 9:90 00 <br />$ 949 — <br />Sewer Bond District Rand ; <br />Abutting Lot Line <br />N, S. E, W fl. <br />Approved By <br />Issued By <br />Customer Signature <br />Inspection By •�"' `' <br />Date Inspected ''- y'yrJ <br />INSPECTION <br />No.27938 <br />