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aHr~ii <br />HEX <br />Hcli <br />(ArA H <br />H <br />z <br />o <br />S <br />off <br />y�.1 V CQJ <br />yy H .3i <br />H <br />A C rn <br />Oto <br />everett <br />e <br />City of Everett <br />Sewer Application and Permit <br />NO. 28290 DATE •lav 30 1991 <br />Service Address iaip 72 + Trt .e c'' Utility Account No. <br />Billing Address 921U Evergreen Val <br />CHART NO. <br />TO POSTING 41- 2 5 -"f 1 <br />va aet 11 99201, Permit Fee $ 30.00 <br />City, State, Zip _ - <br />Owner Lot Inc Connection Charge <br />Connection. by <br />Address — <br />Phone <br />Legal Description: <br />Lot <br />Block <br />Plat Nonte Vista <br />Unplatted Description: <br />Type of Permit _ —_— <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 />Trunk <br />Lateral <br />S <br />Total Connection Charge " $ I ':"kh t10 1" - ; ; <br />Utility Development Fee <br />I41H3 <br />3(IIAVV00t <br />Water <br />11t)t,$ <br />14717900 <br />11.Ia3 <br />145.00 <br />Sewer <br />fAr A—14I'm on <br />Total Development Feel~ <br />'dsiNlno <br />10AM249 <br />µ11I V <br />14%.00 <br />Sewer Bond District <br />INA-kW90 <br />I <br />11,1171111 <br />t I79. on <br />Abutting Lot Line <br />;t711'p <br />1471.11(I <br />`k.!!F' <br />•ih.rq <br />N, S. E. W <br />010 <br />iy All — n• <br />Approved By <br />Issued By <br />Customer Signature <br />/f <br />Inspection B( ' / <br />Date Inspected 62Z2 <br />INSPECTION <br />NO. 28290 <br />