Laserfiche WebLink
Cox <br />C H <br />Y H rn <br />y � 3 <br />�H0 <br />00� <br />H b <br />n• o <br />H <br />zH <br />�H <br />HH <br />gCA <br />H <br />�d(A <br />Rp� <br />ti0rrA <br />evelett <br />City of Everett <br />Sewer Application and Permit <br />NO. 28380 DATE <br />Service Address . _ :'e <br />Billing Address Znnr, N� R13td <br />City, Slate, Zip �' ❑e ov�e� <br />Owner — <br />Connection by _ - <br />Address — <br />Phone <br />Legal Description: <br />Lot _ <br />Block <br />Plat <br />Unplatted Description: <br />Type of Permit <br />Remarks <br />Sevor cap -off <br />IMPORTANTI <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 />CHART NO, <br />_'?0J Z <br />TO POSTING ----- <br />Permit Fae $ ' `^ <br />Connection Charge <br />Trunk $ <br />Lateral $ <br />Total Connection Charge $ <br />Utility Development Fee <br />NMI 91 10::7sth 0OWNRZ9 11l' <br />Water <br />;Pr�y�+�(�-��^q[i3HB <br />Sewer IT <br />ill ..r <br />Total Development Fee 4.1. $"''0 <br />Sewer Bond District <br />Abutting Lot Line <br />N, S. E, W — <br />Approved By <br />Issued By <br />Customer Signature <br />Inspection By _ <br />Date Inspected <br />INSPECTION <br />7ic'G <br />No.28380 <br />0 <br />