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everett l' _ .. <br />, , <br />� I _,� .�. �- - <br />` � � �� �. <br />City of Everett <br />Engineering Department <br />Sewer �►pplication and Perr�it <br />N0. �v � 4 O DATE <br />Serv�ce Address — <br />Billing Address_ — <br />City, State, Z�o—_ ' _— <br />Owner (Mnrtgagorl_ _ � <br />P,iiling Name_ _.___� <br />Conner.ticn By_—_�' - <br />Address_.' —__ <br />Phone —_ —.— — <br />DESCRIPTION: <br />Lot _ _ <br />Block <br />Division or Addition___ • <br />Remarks: , , - <br />��c::75J <br />_ _ _ Utility Acrount Nc <br />Cannection Permit <br />l <br />Cor nect on F �e_ <br />Total 'ree _ <br />Signcd — <br />c��s�o�,��� <br />SEE SKETCH ATTACHED � <br />� � �� <br />SEwerGistri,t _ <br />Monthly Sew�r Service <br />Mn.rthly Se���cr Constr <br />4�iproved By _ <br />� �! Englnrcr <br />Is�ued <br />Connection By_- <br />Inspection By <br />Date Inspected <br />