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everett <br />City oi Everett • � _ _ _ � <br />Sewer Application=and_ Permi# <br />� - -_ :_----_. <br />' ' J ' <br />. J = v: .+ T �y '� S � . �' <br />No. 2 8 � 5 5 DATE e�nrch L 1��1 ' <br />Service Ac'dress ?Q - �trh s� R++ <br />Bllling Address —pg�x <br />City, State, Zip —�y � — <br />Owner <br />Connecticn by ' e.� rC �'Co Q �,rT s _ <br />Address — <br />Phone <br />J <br />Legal Description: <br />Lot <br />Utility Account No. <br />PermitFee $ <br />Connectlon Charge <br />Trunk <br />Lateral <br />CHART NO. <br />S P,+-I- Ia �es�, ,� y <br />7-�� -q/ <br />$ <br />$ <br />Total Connection Charge $ <br />Utility Developmont Fee <br />Water <br />Sewer <br />• �� <br />Block — Total Development Fee $ 650.00 _ <br />Plat <br />ys e <br />Unplatled Descriptlon: Sewer Bond District r r..r�e� <br />Type ol Permit �� �r� <br />Remarks <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 />Abutting Loi Line <br />N, S, E, W <br />Approved By <br />Issued By _ �- <br />� , i <br />Custamer Signature _ <br />� �. <br />Inspection By -�'2i�`"" � � <br />Date Inspected �-y� y� <br />No. 28155 <br />ft. <br />