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everett <br />� % 6- �= °� _ � <br />��� �-�-- <br />. _. . J . ._ . . <br />City of Everett <br />Engineering Department <br />Sewrer Applic�tion and Permit <br />N0. ci'0158 � DATE --,�+.�—"--,. , <br />� <br />Service Address -"r`+` 1' �- �,'- i�, l `�` Utility Account No.. <br />Billing Address ."'� �`"' Connection Permit F <br />City, State, Zip '-' ,i :=���; i�. ' <br />Owner (Mortgagor) ' <br />Billing Name <br />Connection By •;i.' % :l. ; <br />Address - � -' '�i: :r-; ;: / , : �i <br />�� <br />Phone ' � ' <br />DESCRIPTION: <br />Lot <br />DIVGK <br />Division or Addition • <br />Connection <br />Total <br />�. <br />�i <br />Signed �' � ' � <br />� Customer <br />SEE SI<CTCH ATTACHED <br />I� !SI'I: C (�Ir�f � <br />Sewer <br />Monthly Sewer <br />Monthly Sewer Constr <br />Approved By ' " <br />City IEnginccr <br />Issued <br />Connection <br />Inspection 8y�l��u�� <br />Datelnspected � /3�j <br />�. <br />