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Sewer Appl <br />23308 <br />M <br />CHART NO. <br />to rosTitrc I,-,; YZ <br />Od 1 <br />88 8 u388,9 8-� I1 <br />� M <br />ication an Prat _ <br />,s <br />DATE 7-6-92 <br />Service Address <br />1321 63cd St SE <br />Billing Address <br />7114 212th St BE <br />City, State, Zip <br />Woodinville WA 98072 <br />Owner _ <br />Nrrkri Corp <br />Connection by <br />Owner <br />Address <br />Phone 481-8467 <br />Legal Description: <br />Lot 2 of Short Plat 26-91 <br />Block <br />Plat - <br />Unplaued Description: <br />Type of Permit <br />Remarks <br />new connection <br />IMPORTANTI <br />CALL 1-800-424-5555 48-HOIJRS <br />PRIOR TO DIGGING <br />CALL 259.8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Utility Account No. <br />Permit Fee $ _ tu,�r, <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 />M1 <br />179.00 <br />471.00 <br />650.00 <br />f. <br />inspection By — <br />Date Inspected <br />INSPECTION <br />