Laserfiche WebLink
�:i <br />C 3 <br />ru <br />u <br />everett <br />e <br />City of Everett <br />Sewer Application and P6r iI <br />NO. 28220 DATE ___bp. 'l 191 <br />Service Address 2276 74th 5t Ell <br />Billing Address qua tti wn tpew�■_X �2 <br />City, State, Zip <br />Owner — *�— <br />Connection by <br />Address <br />Phone <br />Legal Description: <br />Lot — <br />Block <br />Plat -- <br />Unplatted Description: <br />Type of Permit %*0 ne ton — <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 />Utility Account No. <br />Permit Fee $ <br />Connection Charge <br />HART NO. <br />Tn PnSTING ''-'i �z <br />Trunk <br />$ i7o on <br />Lateral <br />$ <br />Total Connection Charge <br />$ — 270 00 <br />Utility Development Fee <br />Water <br />$ go <br />Sewer <br />$ <br />Total Development Fee <br />$ 6cn 00 <br />Sewer Bond District _ --^ Zz <br />Abutting Lot Line <br />N, S, E. W h' <br />Approved By <br />Issued By ! _ <br />Customer Signature <br />r <br />1, J� L./Ll� <br />Inspection By / <br />Date Inspected <br />NO. 28220 <br />R <br />INSPECTION <br />