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everett :'� - ! � ; _ ", - 5 <br />� /) <br />City of Everett <br />Engineering Department <br />Sewer A,pplicati�n and Permit <br />_^ � <br />N 0. �_U O 2_L DATE <br />Service Address��G ���2 � GCu 5]� Utifity Account No. <br />Billing Address Coni�ection Permit Fee ^'-----' <br />City, State, Zip � t� Connection Fee <br />Owner (Mortgagor) � ' ' ' - Total Fee <br />Billing Name <br />Connection By "' — <br />Address �� � '� Signed � � _ <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addition - ' <br />SEESKETCH ATTACHED <br />INSP[��ION <br />Sewer DistC .t <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Approved By ' <br />Ciry Engincef <br />iss��d ay � ' <br />Connection By -- <br />Inspection By <br />Date Inspected ` <br />