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everett <br />City oi Everett <br />Sewer Application ar�d Permit <br />NO. ?$27Ei DATE Ftay 1�, 1��1 __ <br />Service Address _ 101 = 75th St St;_ Utility Account No. <br />cHnF�1 Na - ----- <br />TO POSTINr, �� �9 a� <br />Billing Address �o aoz 530a <br />City, State, Zip Evezott WA 9U20G Permit Fee $_ 30.00 <br />Ownsr nuisrain oev. __ Connection Charge <br />Connectwn by s��+ — Trunk e— <br />Address — Lateral $ <br />— - Total Conneclion Charge $ _ �� <br />Phone 33�5o1e <br />Legal Deacription: <br />Lot 30 <br />Block --- <br />Plat <br />Unplatted Description: <br />I.ena <br />Type of Permit Nev wnnoction <br />Remarks <br />IMPORTRNTI <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DICGING <br />CALL 259•8810 FOR IhSPECTION <br />SEE SKETCH ATTACHED <br />Utility Development Fee <br />Water $ 179.00 _ <br />Sewor �i,.i�J �a?�;n04.�,. <br />TotalDevelopmeniFee,;�,$,,,,;,� 65G.00_ <br />i�i;n, �; , •.�,. <br />I �!a. . . .�n <br />Sewer Bond Disirict �� I (�etlted) <br />, . .� � <br />Abutting L�.t Line �'� "t�•; ' '' '�' <br />�iia,ii, �.. , , <br />N,S�F�W _ �;rs:�6 , �_rri ft. <br />II':1 � �.J��t.iqi <br />Approved By —�;�-� �.,, <br />Hnr arat !{� d ,� •��,��� <br />Issued By _ ,� �.-- <br />Customer Signature — -- <br />y � <br />Inspectian By %'�'-�` l� <br />Date Inspected ��' - �-�� <br />r�r , <br />NU. 2 C' ��. 7 6 <br />� <br />