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everett `� "rI-;�%r`�S <br />� <br />City of Everett <br />Engineering Department <br />Sewer Appli�ation and Permdt <br />NO. w'�� �l �' '�� DATE <br />ServiceAddress_iL''�'� ��N�� <br />Bi!ling Address <br />City, State, Zip <br />Owner (Mortgagor�_ <br />Billing Name <br />Cannection By — <br />Address__ � <br />Phone <br />DESCRI�'TION: <br />Lot <br />131ock_ <br />Uivision or Addition <br />Rr.marks: �L���-rio.r/ <br />., – ' _ <br />� «, � i <br />— � T— � <br />' i . <br />l i.. i��-.1,�� �-i:,i _".d=:.v.::.:r; � <br />, . . . .... , r�. .. _ _ _— — <br />� <br />SEE SKETCH ATTACHED <br />Utility Account No. <br />Connection Permit I <br />Ccnnec[ion Fee_ <br />Totzl Fee _ <br />Siyned <br />Sewer Disvict <br />Monthly Sewer Service <br />Monthly Sewer Constr <br />Approved Ey <br />Ciry Engineer <br />ISSUCC� <br />Connection <br />!nspection <br />Datelnspec <br />� <br />