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D <br />City of Everett R. 88 s <br />? ro <br />Sewer Application and-1 <br />6 1 "10 �' <br />No.28735 LATE 6/1 <br />124 69th P1 88 (ALB) <br />Service Address — - --- <br />Billing Address 18404 104th Ave i:'L <br />City, State, Zip Bothell AA 98011_____ <br />Owner _— Abode Ltd. _-____-- _ <br />Connection by <br />Address - <br />Phone <br />Legal Description: <br />Lot 3 <br />Block <br />oia, <br />Unplatted Description: _ <br />Type of Permit now connection <br />Remarks <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 />s sssl� <br />ov • � M <br />Utility Account No. <br />CHART NO. — <br />TO <br />Permit Fee $ _- 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 />$ 270.00 <br />$ 450.00 <br />$ _ 720 o0 <br />$ 261.00 _ <br />$ _68 800 <br />$ — —90 09 <br />CD <br />Inspection Byq <br />Date Inspected <br />INSPECTION <br />No. 28735 <br />ft. <br />E <br />