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u, <br />r <br />ssss�s s ss <br />ri <br />Sewer Application Ond P _ ' Q <br />IN <br />29106 3ai3": <br />DATE <br />Service Address <br />2518 74th St SE <br />Billing Address <br />PO Box 2266 <br />City, State, Zip <br />Everett WA 98203 <br />Owner <br />Lyle E Blank <br />Connection by <br />Address <br />Phone <br />Legal Descriptlun: <br />Lot <br />1 <br />Block <br />4 <br />Plat <br />SP 626-92 <br />Unplatted Descripilon: <br />Type of Permit <br />Nov 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 />Utility Account No. <br />CHART NO <br />POSTING <br />Y <br />a <br />M <br />8 <br />Permit Fee $ <br />Connection Charge <br />Tn nk $ <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 />70.00 <br />0.00 <br />$ 179.00 <br />$ 471.00 <br />$ 550.00 <br />N, S, E, W ft. <br />Approved By <br />Issued By OB <br />Customer Signature <br />Inspection By <br />Date Inspected <br />INSPECTION <br />2S16 <br />