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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 /> 005 5 C M Evc.ct.r-r W4 9 <br /> PROJECT ADDRESS <br /> i\05 Evia (:4) /2�D L.15---376?-7441. <br /> Property Owner Mail Address City State/Zip Phone <br /> Tenant Name(If this is for a commercial business) <br /> (-�0-1. iki^ S rte Z-41- jar Q 3. <br /> Contractor Mail Address City State/Zip Phone <br /> EST' ;'Gi, `17-7) c_D . ® �D`�t� <br /> WA State Contractor License Number(required) City of Everett Business License Number(required) <br /> Work to be done: <br /> )7` Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer— New Installation <br /> Install Backwater Valve (outside the building) <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter <br /> FEE <br /> ir <br /> / /C/ ( / PERMIT# <br /> Si ,-gnatuDate <br /> U . . 70— c <br /> REVISED 11/19/2014 <br />