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� <br />� <br />A xl 5C <br />�Ha-+i <br />y��-�i <br />� H .7�0 <br />'�9y� <br />Z <br />�O� <br />ON <br />��g <br />C�]r (� <br />t"y� <br />Hy <br />N <br />C� C7 t� <br />� <br />xy� <br />HOfA <br />� <br />� <br />` � <br />i �� <br />� <br />�� � <br />everett <br />� � <br />� <br />I <br />� [ 4 " _ _ _ <br />� City of Everett <br />Sewer Application and Permit <br />i. _ � -. :. . �.. � .: .: . <br />NO. 28� %'; DATE __ ;!nrc:�_t:, 1�91_ <br />Service Address il�� -��i1 ��- ���- ---- Utility Account No. <br />Billing Address �1J ��nci� ave <br />i <br />CHAHiNO. ----- <br />� � �os�,ti y �o�/b�qi <br />� Ciry, State, Zip —+�+ LY6xllls.-S�� yn' 1� Permit Fee $ _ <br />Owner Ftet�aeon Cuurc Inc Connection Charge <br />i Conneclion by � �"""�"� � — Trunk $ <br />' Address — Lateral S <br />Phone ��b-Y412 _ _ _ <br />Legal Description: <br />Lot � —_--- <br />Block — <br />Plel _ li�s►y^ !-' ilC <br />Unplatted Descr(ption: <br />Type o� Permit _ `�`'w connectlun <br />Remarks _ <br />IMPORTANT! <br />�o.00 <br />-U- <br />Total Connection Charge $ _— __ <br />_____ Utilily Development Fee <br />Water $ 17?.uJ <br />411.U0 <br />___._ Sewer $ ' <br />_— Total Development Fee $ G50.00 <br />CALL 1-80D-424-5555 48•HOURS <br />PRIOR TO DIGGING <br />CALL 259•8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Sewer Bond District lion� I(retired) I�� <br />Abutting Lot Line ' <br />N, S, E, W �� <br />Approved By <br />Issued By tf°ignreC hlcLaod I <br />Cus�omer Signature -- ---- � <br />�/� <br />Inspection By ___ � "t • l� � <br />Dale Inspected __.__��/ �' -- <br />No. 28173 <br />