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everett <br />_: <br />t <br />:T <br />City o1 Everett w `� _ _ _ _ _ ', <br />! - . ;., <br />Sewer App�icatio���nd"Permit <br />�: <br />: _��`�`�'='�-� <br />._ . , � �. 4 =' -J ,- { ' . <br />NO. [�1�� DATE ���,, i�= i��i <br />Service Address �� ;� +� � � <br />BillingAddress ---�����--- <br />City, State, Zip <br />Owner I <br />Connecilon by 1n�n,..�,r.n�% � Q� ce�c S <br />Address — <br />Pl�one � <br />Leyal Description: <br />Lot 24 <br />Utility Account No. <br />Permit Fee $ <br />Connection Charge <br />Trunk <br />CHART NO. <br />Seh� la ���s��n`� <br />� "��' 11 <br />$ <br />Lateral $ <br />Tolai Connection Charge $ <br />Utility Developmont Fee <br />Water <br />Sewer <br />$ <br />$ <br />Block Total Development Fee $ . <br />Plat <br />Unplatled Descriptlon: Sewer Bond District f� -�--�� - <br />Type ol Permit <br />Remarks <br />IMPORTANTf <br />CALL 1-800-424-5555 48•HOURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR IH3PECTION <br />SEE SKETCH ATTACHED <br />Abutting Lot Line <br />N, S. E, W — <br />Approved By _ <br />Issued By r- <br />Customer SignaWre <br />Inspection By -���� `" � <br />Date Inspected 7- � ' y/ <br />I�JSI'f CIIOhJ <br />No. 281fi2 <br />ft. <br />