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n� <br />�1 y <br />aHr~n <br />�'3Z <br />lid H It <br />M <br />H <br />O <br />H C7 <br />O N <br />� tr <br />n. a <br />t. z <br />r z <br />rt H <br />8 0 <br />oey <br />HON <br />C ,_ <br />1 is <br />ri I <br />C D <br />everett <br />r- <br />5�885�8 8g 88 <br />City of Everett N n}y 4 yp <br />M M q ... i <br />Sewer Application d Perinifl2 <br />m�im <br />N0. 28181 DATE Harch 12, 1991 <br />Service Address 18 - 75th St SW <br />Billing Address L 1 it Rw c ice <br />City, State, Zip — <br />Owner <br />Connection by Same <br />Address <br />Phone. ---- <br />Legal Description: <br />Lot --- <br />Block - ----- <br />Plat n+u t ^ -- <br />Unplatted Description: — <br />Type of Permit <br />Remarks <br />New connect <br />IMPORTANTI <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECT13N <br />SEE SKETCH ATTACHED <br />Utility Account No. <br />CHART NO <br />Sc�f ?us-{„t`l <br />7 - 2_6 -411 <br />Permit Fee $ <br />Connection Charge <br />Trunk $ <br />Latpral $ <br />Total Connection Charge $ <br />Lltil'ty Development Fee <br />-r•- <br />Water $ 179.00 <br />Sewer $ 471.00 <br />Total Development Fee $ Rsn o0 <br />Sewer Bond District Bonc4 I <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />Issued By jjramrar <br />Customer Signature — <br />A� <br />Inspection By <br />Date Inspected <br />INSPECTION <br />NO. 28181 <br />• --- l:fLlNt <br />