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everett <br />� <br />City of Everett <br />Engineering Department <br />Sewer App�ication and Permit <br />NO. <br />i`.� �? �' " DATE <br />Service Address ' � / � OC /��f��� <br />Billing Address <br />City, Sta[e, Zip � <br />pwner (Mortgagor) ` � —� <br />Billing Name — <br />Connection By—_-----=-=— <br />Address � � � <br />DESCRIPTION: <br />Lo: _ <br />Bloch� " <br />Division or Addition_ �� <br />Utility Account No. <br />Connection Permit I <br />Cannection Fee_ <br />Total Fee <br />Signed <br />� <br />�— <br />Sewer District_____ <br />"llonthiy Sewer Service J <br />�lonthly Sewer Constr. <br />/ <br />J <br />S[E SKETCH ATTACHEd <br />4pproved By — <br />c�ry <br />ISSUe� BV <br />Connection By <br />Inspection By /� C�l� �� � <br />v <br />D.te Inspected �^� — —=� - <br />