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everett <br />� <br />City a� Everett <br />Engineering Department <br />-� . �! -- ldc.Y ""' <br />:�- „_ '7. <br />_ s') !ll' A��. <br />Sewer Applitation and Perrnit <br />T. �� , . <br />N 0. r':1 ._. � — <br />Service Address_ <br />13illing Address_ <br />City, State, Zip_ <br />Owner ("�ortyagor�_ <br />Billing Name <br />Connection By_ <br />Address <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addition <br />DATE <br />Utility Account No. <br />Conneciion Permit I <br />Connection Fee_ <br />iotal Fee <br />Signed_ c���ome� <br />Sew�r Distnct__— <br />�UlontSily Sawer Servi:.e, <br />Montlily Sewer Constr. <br />SEE SKETCH ATTACHED <br />Lateral <br />Abutting Lot Line <br />N, S, E, W. <br />A� proved BY Citv Engineer <br />I ssued <br />� <br />Inspection By <br />Date Inspected_'`�'�' <br />N 0. � �._ % �J �'_ <br />