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CHART NO. .— <br />everett <br />z: <br />'� <br />R <br />T <br />. � �' �^ :�' f'' z. t <br />City of Everett ; : ' ' _ - - "� <br />�_� , •r �� , � <br />Sewer Appticatio��_�n�"Perr��it <br />�^ 'yr `' 1 i ay �� =� W S(' � <br />NO. Z�� � R'1 W�� DATE� j'�w,n.t,�2.r.1�91 --- <br />SBNICB AddreSS _ �7 – �* ��„�-- <br />BIIIing Address — <br />Cfty, State, Zip <br />Owner , <br />—�i — �. <br />ConnecUon by _ <br />Address <br />Ftione _ <br />Legal Descrfption: <br />Lot » <br />Block <br />Plat — <br />Unplatted Description: <br />Type of Permit qwv (1�nnnnNnn <br />Remarks <br />IMPORTANT! <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CpLL 259•8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Utiliry Account No. <br />Permil Fee $ <br />Connection Charge <br />Trunk <br />Lateral <br />�otal Connection Cherge <br />Utility Development Fee <br />Water <br />Sewer <br />Total Development Fee <br />� ���Sf'M <br />7—�� y� <br />$ <br />$ <br />$ <br />$ --Tri��t-- <br />$ d7-'�.99 <br />$ <br />Sewer Bon� District t (swti�nd; <br />Abutting Lol Line <br />N, S, E, W h• <br />Approved By — <br />Issued By--r <br />Cusromer Signature <br />Inspeclion By _ <br />Date Inspected <br />irasrrciiotd <br />�� <br />3- .2 S'- �i <br />NO. ZS161 <br />