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everett <br />� <br />City of Everett <br />Engineering Department <br />�; ( � � � �,��=? <br />� ` ��_�" <br />�, <br />, , <br />;. -;.:� <br />Sewer App���ation and Pe�mit <br />No. 10 0 i n, � GATE <br />ServiceAddre,s a��! �K��'��� <br />Billiny Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Connection By <br />i, <br />Phone <br />DESCRIPTION: <br />Lot <br />Block_ <br />Division or Addition <br />i <br />Utility Account No. <br />Connection Permit I <br />Connection <br />Total Fee_ <br />Signed Cusmmcr <br />Sewer Distnct <br />"4onthly Sewer Service <br />flonthly Sewer Constr <br />SEE SKETCH ATTACHED <br />�pproved BY c�ty E�g��e�r <br />Issued <br />Cpnnection By--���_�� <br />,� �� -. .� <br />Inspection By '"� '�� �Gi'- <<. - <br />Date Inspected�,'�� � — <br />� ' <br />