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everett <br />City of Everett <br />Sew�r Appl <br />No. 28151 <br />.'S'I"��` � : CRT� <br />- �r — - - ,-c'��' <br />.. - .. � .. {' � � � <br />ication and _P�rrrr.it � ` <br />� `� -ri � ' <br />t'-` •_ _ •_ <br />�,1�. ' '_ _ '. ... -. _ i.'� -� " _ �t <br />. �/{ 1 E �Mwrnh C+�] �101 <br />Service Address ;,�� - �e*� e• M� — <br />Billing Address <br />City, State, Zip �� <br />Owner . <br />Conneclion by o�m r W ea:'�,e��.� ���a SeYei <br />Address — <br />Phone _ <br />Legel Doscription: <br />Lot <br />Utility Accoun� Nu. <br />Permit Fee $ <br />Connection Charge <br />Trunk <br />CHART NO. <br />� <br />�M <br />� <br />J �> ,, { �� � r,s�i;.� y � -.zc - `%� <br />$ <br />Late�al $ <br />Total Connection Charge $ <br />Ulility Devetopment Fee <br />Water <br />Sewer <br />Block — Total Development Fee $ �S� �� <br />Plat <br />Unplaned Description: Sewer Bond District I fretire8l <br />Type o( Permit ��� <br />Remarks <br />IMPORTANT! <br />CALL 1-800•424-5555 48-HOUFlS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />Issued By — - <br />CustomerSlgnatU ;1.� � ' ' � <br />� — . <br />Insper.tion By �� <br />Date Inspected 3 t`i q _ <br />INSPECI iOFd <br />No. 28151 <br />n. <br />