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everetl <br /> � ` ,. <br /> �" <br /> � � ;� <br /> ��; <br /> City of Everett <br /> Engineering Department <br /> Sewer Application and Permit <br /> _ , � <br /> � �, "c� ?S <br /> N0. �-' i '. - DATE <br /> Service Address � `" Utility Account No. <br /> Bi!ling Address Connection Permit Fee r � <br /> City, State, Zip >'�` Connection Fee y <br /> Owner (Mortgagor) < '•' ' Total Fee <br /> Rilling Name <br /> Connection By <br /> Address ,'� �'� �. �-•: Siyned <br /> • Cus�amer <br /> / <br /> PhOnO — -- <br /> DESCRIPTION: <br /> Lot _ <br /> Block <br /> Division or Addition <br /> Sewer District <br /> Monthly Sewer Service <br /> Remarks: "��" •> ;'il'�v <br /> Monthly Sewer Constr. <br /> l,e-.,�G��t,�i � 1.,n�a.c.�- ,G�� � <br /> Approved By -- <br /> �� / ` l CiIY Englncer <br /> „C (.(�k{ <br /> _ _ Issued By -- — <br /> __ Connection By <br /> Inspection By � r�""!� <br /> -, <br /> Date Inspecied__`�� �� ___ -- <br /> : — <br /> 7 <br /> SEESKETCH ATTACHED <br /> I�'SP[C <br /> c <br />