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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 /> CT <br /> /2- Cl 1 I 2,i <br /> PROJ CT ADDRESS <br /> lqoAvew ;4Iic( /lif -filo7/0 g�`L(�� <br /> Pro erty Own r Mail Address City State/Zip Phone <br /> Tena t Name(If this is for a commercial business) <br /> 'CrldiV <br /> Contractor it Address City State/Zip Phone <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 /> ❑ Side Sewer— New Installation <br /> ❑ Install Backwater Valve (outside the building) • <br /> ❑ Cap off Sewer <br /> V Install Water Meter-3/(411 <br /> FEE <br /> I <br /> PERMIT# <br /> Signature I �te 41, tli tg 0,00 <br /> REVISED 11/19/2014 <br /> V <br />