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1 . <br />everett <br />e <br />City of Everett <br />Engineering Oepartment <br />Sewer Applicat <br />rvo. �.0�_i?; <br />Service Address_ <br />Billing Address_ <br />City, State, Zip_ <br />Owner (Mortgagor)_ <br />Billing Name <br />Connection Bv <br />Phone <br />DESCFIPTION: <br />I_ot <br />Block __ <br />9ivision or P,dditi <br />I: <br />i�n and Permit <br />.. : <br />Utility Account No.__ <br />Connection Permit Fee - <br />Connection Fee <br />Total Fee <br />._ -r � _ <br />01+ : '' Signed <br />c����om« <br />�, — <br />� <br />SEF Si:�TCH ATTAI;HED <br />Sewer District _ <br />Monthly Sewer Service_ <br />Monthly Sewei Constr._ <br />Approved By <br />Ciiy Engincer <br />Issued By _ _ <br />Connection By _ <br />Inspection By � - �-"��� �°.J <br />Date I r,spected_; .2 �i 7 z— _ <br />