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everett <br />City of Everett R 8 8 8 8 <br />L , <br />Sewer Appliccetti4n and <br />NO. 28736 DATE b <br />Service Address _ 116 69th Pi SE (A&Bj <br />Billing Address 18404_ 104th A.,e 8p <br />City, Slate, Zip _ R�rhal l WA YRQ11 _ <br />Owner Abode Ltd. <br />Connection by <br />Address <br />Phone <br />Legal Despription: <br />Lot —_ 5 <br />Block <br />Plat <br />Unplatted Description: <br />Type of Permit <br />Remarks <br />New connection <br />IMPORTANTI <br />iM <br />$888 <br />prg�z <br />Utility Account No. <br />TO POSTING <br />PermilFee $ 30.00 <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 />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Inspection By _ <br />Date Inspected <br />INSPECTION <br />$ 270.00 <br />$ 450.00 <br />$ 720.00 <br />$ __ 261_00 <br />$ 688.00 <br />949.0 <br />NO. 28736 <br />