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everett <br />City of Everett <br />Sewer Applicat <br />No. 28010 <br />ICHART NO. <br />TO COSTING <br />ion-,aod Pprrvit w " <br />1 <br />LA <br />DATE'- 11/07/90 <br />Service Address 2238 74th St SL <br />Billing Address I2a15 u..l,tltao Bpdwr 62 <br />City, State, Zip _ <br />Owner <br />Connection by <br />Address <br />Phone <br />Legal Description: <br />Lot <br />Block <br />Plat <br />Unplatted Description: _ <br />Type of Permit <br />Remarks —_ <br />Rvinn V4Mte If... T...I. <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 />Utility Account No. <br />Permit Fee $ *in-oo <br />Connection Charge <br />Trunk <br />Lateral <br />Total Connection Charge <br />Utility Development Fee <br />Water <br />Sewer <br />Total Development Fen <br />Sewer Bond District <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />Issued By <br />Customer Signature <br />a <br />$ 270.00 <br />$ 179.00 <br />$ 471.00 <br />$ f,sn-On <br />Inspection By <br />Date Inspected 42gi <br />INSPECTION <br />NO.28010 <br />ft. <br />