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L��� <br />��� <br />ayx�� <br />H x� <br />� H� <br />�H� <br />Vl H <br />�O� <br />O H <br />H I��7 � <br />�j] V (�] <br />'" � � <br />:? H <br />�yz <br />'� H <br />g`� <br />H <br />c� r� �n <br />��th <br />HOCy/� <br />everett <br />� � <br />� <br />i City of Everett <br />ic:HART N0. <br />Si•n { �?� �oSr,� <br />�4�So�4( <br />' Sew�r Applic�tion a�d Permit <br />N0. 2 B���' DATE _ s�-a.-i���-- -- - <br />� �.. <br />�I Service P.ddress 17 _75th st r---___- _--- <br />�i Billing Address -.�-7�IIn t;R�r r�r <br />', City, State, Zip _�,isklaad-oal�-?J�]� ----- <br />� Owner --i�nle--I,loyd--- - - - _ _ --- <br />Connection by __��-_��t=.�.f�-�-- - - <br />Addross _ � ----- --- __ . - - <br />� <br />Phon� n»_d75L____-------.._. _- --- <br />Legal Description: <br />Lol —_17_------- --- - — - <br />Block - -- - <br />Plal _ Pidqn i.ane__ _ ... .._ <br />Unplatted Description: __ - -- - - <br />! Type of Permit Ft�v eonnaction _ <br />� Remarks —_____- -_.-._--- - <br />IMPOHTANT! <br />CALL 1-400-424•5555 4f3-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />SEE SKETCH ATTACHFD <br />Uliliry Account No. <br />PermitFeo $ �hiAi.`i �,j,_�:�'�a:t:;.�t9 ; <br />Connection ;hargn ���'°I'� �;'" <br />i:� :,, �,� <br />Trunk �i�iS ' ` - <br />��J � II 1..i�.iEi <br />Lateral ; ,$;----�-�tt- <br />i;��ii, r��t� <br />lotal Connection Chargg, ,, $ ,.._ <br />Utilitv Developmont Fee ' "` � ��. �� <br />I i � i , .. . � R � <br />Wate� :.u���9,._� 153 00 <br />I,a�III' :I u.iYl <br />$CW�t t IiF(S 400'00 <br />Total Developmont Fee $ —_gS2.D0- <br />Sower Bond District <br />Abut�inc� Lot Line <br />N. S, E. W— n. <br />Approved By _ <br />Issued By -- _..__-_— perqerot HCLoo� <br />Cus�omcr Signa�ure . . . . - _ - ------ - -� - ---- <br />InspectionBy- �'��`�� � — <br />Dalo Inspeclad 'f �� �� <br />No. 28247 <br />