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CHAH i NO. -- <br /> elrerett - <br /> em <br /> City of Everett v <br /> Sewer Application and Permit, <br /> Hu <br /> 'l 5 9 DATE January 2, 1941 <br /> No. 2 8, _-- <br /> Service Address 102 76th St SW_ Utility Account No. <br /> Billing address I)n - 76r1• e• OU <br /> City, State, Zip _ Everett VA 98203 Permit Fee $ 2.50 <br /> Owner Arthur Taft Connection Charge <br /> Connection by nvnwr Trunk $ <br /> Address _ Lateral $ — <br /> Total Connection Charge $ <br /> Phone Utility Development Fee <br /> Legal Description: Water $ <br /> Lot Sewer $ <br /> Block _ _ Total Development Fee $ <br /> Plat <br /> Unplatted Description: Sewer Bond District <br /> Abutting Lot Line <br /> N, S, E, W ft. <br /> Type of Permit cap off /1 Approved By --- <br /> Hemark 1A V8 Issued By tlarraret 1!cl,eoz <br /> �y tA Customer Signature <br /> IMPORTANT! <br /> t KI91 <br /> CALL 1-800-424-5555 48-HOURS <br /> PRIOR TO DIGGING <br /> Inspection By <br /> CALL 259-8810 FOR INSPECTION <br /> Date Inspected <br /> SEE SKETCH ATTACHED NO. 28059 <br /> INSPECTION <br />