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� ;IiARi NO. --- — <br /> everett <br /> TO POSTING 10, <br /> pCity of Everett <br /> C H <br /> H to <br /> H H I Sewer Application and Permit <br /> K n <br /> H0 <br /> OSO <br /> yH NO. 28000 DATE _9cionnz_a - loon I <br /> z <br /> 80 Service Address Utility Account No. <br /> H M g Billinr Address 611 cant-s' 0, <br /> Q. c� <br /> zy City,State,Zip —grexettjPermit Fec $ <br /> H y Owner rsawsre, f rsh+ler — Connection Charge <br /> N <br /> H <br /> Cl y Connection by _ _ Trunk $ <br /> M Address — — — Lateral $ <br /> o <br /> co <br /> Total Connection Charge $ <br /> Phone _—;T;��fg_ -- Utility Development Fee <br /> Legal Description: Water $ —ui go <br /> CZ) Lot Sewer $ eas_no <br /> Block — Total Development Fee $ CIO 00 — -- <br /> Plat 8P 25-09 — --- <br /> law&a, Unplatted Description: —_ Sewer Eond District —���— - <br /> _ Abutting Lot Line <br /> N, S, E,W — h. <br /> Type of Permit _=t.,_ j" — Approved By <br /> Ll Remarks _ ---. Issued By <br /> _ Customer Signature <br /> IMPORTANT! <br /> CALL 1-800-424-5555 48-HOURS Je V <br /> PRIOR TO DIGGING 0 �— <br /> CALL 259-8810 FOR INSPECTION Inspection By <br /> Date Inspected _— <br /> SEE SKETCH ATTACHED N0. 28000 <br /> INSPECTION <br />