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i <br /> CHART NO. — <br /> e tt <br /> to <br /> N City of Everett <br /> M and Permit App1icaion _ s b <br /> �c NO. 28972 � DATE <br /> Fw �f• Utility Account No. <br /> H Service Address --1�.G—t<L� F'� y <br /> N <br /> NH Billing Address — 29,' — <br /> E; City,State, Zip Permi! Fee $ '^ ^^ <br /> N <br /> OwnerConnection Charge <br /> e ec orree nc <br /> � <br /> Connection by ^a' <br /> Address <br /> Trunk $ <br /> Address Lateral $ <br /> Total Connection Charge $ — <br /> Phone _ Utility Development Fee <br /> Legal Description: Water $ --Njt. — <br /> r <br /> Sewer $ 471.00 <br /> Lot <br /> I C�1 <br /> Block Total Development Fee <br /> Plat <br /> Sewer Bond District _ <br /> Unplatted Description: <br /> m rn <br /> Abutti.,g Lot Line <br /> N. S. E.W k. <br /> s <br /> Type of Permit Approved By <br /> Remarks Issued By —— — <br /> tuft <br /> — Customer Signature <br /> IMPORTANTI <br /> Q ft <br /> Of 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 N0. 28672 <br /> INSPECTION <br />