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eswr+ <br /> CHART NO. ------ — <br /> everett <br /> x <br /> ' r ; t = TO POSTING <br /> � .3 - <br /> a rx City of Everett <br /> I <br /> y 3 Sewer Application and Permit <br /> 0x CW `• � Ctiz sx <br /> 0HC L <br /> 17 <br /> NO. 28110 DATE __-J-warf. „ ,om <br /> io <br /> W C g Service Address —.9 =7bth Et Utility Account No. <br /> Billing Address —9gp} - 60th i�ca n - <br /> yxy j City, State,Zip Permit Fee $ _ <br /> t� x 395---- <br /> 8 rA H Owner Connection Charge <br /> n b u' Q. C L) Trunk <br /> [� r Connection by <br /> r `� -`- $ <br /> wm Lateral $ <br /> Address <br /> Total Connection Charge $ <br /> Phone Utility Development Fee <br /> Water $ 261.00 <br /> Legal Description: Sewer $ <br /> Lot ___2--__-- -- <br /> --- - Total Development Fee $ <br /> Block <br /> Plat <br /> Unplatted Description: —_ Sewer Bond District <br /> Abutting Lot Line <br /> N,S, E,W ft. <br /> Type of Permit Approved By <br /> YP --th+r�3e�+eet4en-- <br /> 1� Remarks _ Issued By— .t 110e10x33 <br /> Customer Signature <br /> LL�j <br /> IMPORTANTI <br /> CALL 1-800-424-5555 48-IIOURS <br /> PRIOR TO DIGGING <br /> c <br /> Inspection By <br /> CALL 259-8810 FOR INSPECTION Dale Inspected <br /> SEE SKETCH ATTACHED <br /> No. 26110 <br /> INSPECTION <br />