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W <br />City of Everett <br />T <br />a <br />POSTING 8-�u -95- <br />Sewer Application <br />NO. 2 8 21 9 DATE <br />Service Address �av�t gt. GR <br />Billing Address <br />City, State, Zip _.-&�nnwqoA SrA 90037 <br />Owner <br />Connection by <br />Address <br />Phone 355 wn• zoot <br />Legal Description: <br />Lot I_ sr 12n2-6-2n <br />Block — <br />Plat <br />Unplatted Description: <br />Type of Permit _ Now Connection <br />Remarks <br />IMPORTANTI <br />and Permit-, M <br />A <br />Anzil 19 Ionl � i. <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 />Permit Fee $ <br />Connection Charge <br />Trunk <br />Lateral <br />CHART NO. <br />R �8838r�g� <br />M M � <br />7 m <br />888��'c <br />$ <br />Total Connection Charge $ 270.00 <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 />$ — "9 00 <br />$ 47i 00 <br />Issued By <br />Customer Signature ! --— <br />Inspection By U� ` <br />Date Inspected <br />INS1315C l ION <br />No. 28219 <br />ff. <br />