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everen <br />� ? / �� <br />City of Everett <br />Engineering Uepartment <br />\J <br />Sewer Application and Permit <br />� <br />N0. ��!�!� L'i � DATE � <br />,, — <br />Scrvice Addre;s='� ! 7/ �� �C %/�/D.�� Utility Account <br />Billing Address <br />City, State, Zip <br />Owner (Mortga� <br />Billing Name_ <br />Connec!ion By_ <br />Address_ <br />DESCRIPTION: <br />Lot `� <br />Eilock <br />Division or Addition <br />Connection Permit <br />Connection <br />Tota I <br />Signed <br />Customer - <br />_� <br />SEESKETCH ATTACHED <br />Sewer <br />Monthly Sewer <br />Monthly Sewer Constr <br />Approvr,d By :'. � ' <br />CIIV Enginccr <br />I ssu ed <br />Connection <br />I <br />Inspection By ��'��-����4w _ <br />Date Inspected_�Z�//� �— <br />