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everett <br />`: <br />- - - - �y�, <br />��w�: <br />Cfty of Everett - � - _ �_ ` _ ; y , <br />- ..-.. . .., . <br />Sewer Applicatio� aind Perri�it .,. � <br />:J :'�.�z:�'� ='.� � _� <br />i.�.l�« �L �-•� r ' -i' _ <br />NO. Z H 1 S 4 DATE ••--.h �_,�.ai . <br />Service Address -;;; ���+- • <br />Billing Address —iu�-Aox-57o4- <br />City, State, Zip _ <br />Owner _ w;. �+ TM <br />Connecqon by p,�� «1 ^r. � �� e,2. <br />Address — <br />Phone _ <br />Legal Description: <br />Lot � <br />Block <br />Plat aldga *- -- <br />Unplatte� Jescription: <br />Type of Permit �_�,��4a� <br />Rumarks - <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 $ <br />Connection Charge <br />CHART NO. <br />S Q � i {,:- rx�� „y <br />F-zo-q� <br />Trunk <br />Laterat <br />Total Cor.nection Charge <br />Utility Development Fee <br />Water <br />Sewer <br />Total Davelopment Fee <br />$ 17�.00 _ <br />$ 47d ^�---- <br />$ 65�.Q0 <br />Sewer Bond District = tI'alirae) <br />Abutting Lot Line <br />N, S, E, W — n. <br />Approved By — <br />Issued By — — <br />Customer Signature - <br />, <br />��,,.:i <br />Inspection By _ <br />Date lnspected � y - s � -- <br />iusr��_criora <br />No. 2815A <br />� <br />