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�] (�H <br />�x s� '11 <br />G7lH <br />�H�n <br />y�H <br />�H� <br />�N�1 <br />�x� <br />o�� <br />��8 <br />n� c� <br />�y��HH <br />ti <br />guy <br />[� <br />O� <br />� <br />i <br />I �� <br />� �� <br />� <br />� <br />everett <br />� <br />City of Everett <br />CHART NO. <br />Sr�a id �>�� �� <br />s/ }�.�„ <br />S�wer Applicaii�n and Permit ' <br />NO. � R � � q DATE _L'aY_3.�1.1221._ _ — _ <br />Service Address _15=75th_ st su__ _ _ <br />BillingAddress _--1]2Bn i�rrh wr <br />City, Stale, ZIP ---g3rk3awd-u�-AA83<------ <br />Owner _ �a Lloyd __ <br />Connectionby acuz��t^•�^•^r��� �'^'Fz' <br />Address - <br />Phone _ 8]1-475G --. — <br />Legal Description: <br />Lol _� 1 - <br />Block - <br />Plat <br />Unplatted Description: <br />� Type of Permit Naw connaction <br />Remarks -- - <br />I -- <br />IMPORTANT! <br />CALL 1-B00-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />�I CALL 259-8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Utility Account Nu. <br />Permit Feo S _ ___ <br />Connection Charge <br />Trunk <br />Lateral <br />Tota' Connection Charge <br />Utiliry Development Fee <br />Water <br />Sewer <br />Total Developmen� Fee <br />$ <br />$ <br />$ <br />$ _ __ 179 00 <br />$ —�.'�:60 I <br />$ , I <br />Sewer Bond District ��ree4redi — <br />Abuqing Lot Line <br />N, S, E, W— n' <br />Approved By <br />Issucd By ----�; <br />Cuslomer Signature -- � <br />�/ � -- <br />Inspeclion By � ' r ���f! <br />.f - yc - `I/ � <br />Date Inspected __— <br />No.28255 <br />