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ru <br />40ft am, <br />evDt�et <br />IAMI <br />Nq) <br />City of Everett <br />Sewer Application and Permit <br />NO 28112 DATE __ 3x' l abrunry 5. 1991 <br />!i3 i <br />Service Address H-Jim r4cu °t «' <br />Billing Address "" V"'' <br />City, State, Zip <br />Owner steyCU IieC it - <br />Connection by <br />Address <br />Phone -- <br />Legal Description: <br />Lot — <br />Block <br />Plat <br />UnplattedDescrlptlonL' r t+n' of r^c 19 1110el' - <br />)twt r y�i vla v 1 <br />Type of Permit :4ew connection _ <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 />CHART NO. <br />TO POSTING— 11 -zG' <br />Utility Account No. — <br />Permit Fee $ 30.00 <br />Connection Charge <br />Trunk <br />Lateral <br />Total Connection Charge <br />Utility Development Fee <br />Water <br />Sewer <br />Total Development Fee <br />Sewer 9ond District <br />$ 270.00 <br />$ 450 00 <br />$ 720.00 <br />$ 179.00 <br />$ 471.00 <br />$ r.sn_un <br />Ah,ning Lot Line <br />N, S, E, W tt' <br />Approved By <br />Issued By ltarraree t'cLaod <br />Customer Signature — <br />, <br />Inspection By <br />Date Inspected — <br />INSPECTION <br />NO.28112 <br />