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everett <br />�e�� <br />City of Everett <br />Sewer Application and Permit <br />No. 28754 DATE _- r�-R-gz _ <br />Service Address 128 69t)Lpl�)`_ _ <br />Billing Address IR404 In 4 th Ave NK <br />City, State, Zip _IQthell WA 98011_.__ <br />Owner --- own r <br />Connection by <br />Address <br />Phone __ 4R7-2868 <br />Legal Des;ription: <br />Lot __1 cif S.P. 02-89 <br />Block _ <br />Plat <br />Unplatted Description- _ <br />CHART NO. <br />TO POSTING._5--�f--3____ <br />06/10/92 813FMf OMN4291 tell <br />r1 W,VL'1, <br />Utility Account No. <br />BLOO $765.50 <br />NECH $180.00 <br />0 SRC" 16.50 <br />Permit Fee $ snl'i3dA' <br />K I.00 <br />11(gD(39 I53 <br />Connection Charge <br />MITER 5130.no <br />1100 1754 <br />Trunk <br />SLIER 270kpft <br />Lateral <br />I11771 _r— +�"` — <br />Total Connection Charg ONJ6Jui n_1lp <br />Utility Development Fee <br />CGTiII--- <br />MOD $110.00 <br />HEM $1Lin. 00 <br />Water <br />P N411 2614iW0 <br />fi6lA " K70.00 <br />Sewer <br />rARR_nn <br />Total Development FeeIt <br />`F.." s:t0.f1D <br />8141I I $7; 0.00 <br />Sewer Bond District II117t/5 <br />$9417.00 <br />Abutting Lot Line <br />PLN 01 1,50.00 <br />DEG, $5901.00 <br />N, S, E, W <br />ft. <br />Type of Permit nev coaneeticn Approved By <br />Remarks <br />IMPORTANT! <br />CALL 1-800-424.5555 48-Hi URS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOP. INSPECTION <br />SEE SKETCH ATTACHED <br />Issued By MR <br />Customer Signature <br />Inspection By <br />Date Inspected 7 — a— <br />INSPECTION <br />No.28754 <br />