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• ! <br /> WATER/SEWER UTILITY PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.gov <br /> ,6U iocg O L' trlsr <br /> —VP' C ,f - . ( <br /> PROJECT ADDRESS <br /> FoER-_,77 hf ,/4x /7M*'/y 31o2 cozky AtY. 111,54577— / <br /> Property Owner Mail Address City State/Zip Phone <br /> Tenant Name(If this is for a commercial business) <br /> Cc9V 5 . 7"i i,vr-QE' G4-0 9'600/ b-' ' <br /> Contractor Mail Address City State/Zip Phone <br /> A- /E'cgOoErV c3/z <br /> WA State Contractor License Number(required) City of Everett Business License Number(required) <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> 111" Side Sewer— New Installation <br /> 0 Install Backwater Valve (outside the building) <br /> 1 NOV 0 S 2015 • <br /> 0 Cap off Sewer <br /> sir. <br /> let:. <br /> O Install Water Meter <br /> FEE <br /> n� p:51 <br /> t2- ci(ji 1 J PERMIT# <br /> Signature ateD / <br /> REVISED 11/19/2014 <br />