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WATERISEWER UTILITY PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREFT, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 - www everettwa gov <br /> �,3 �1 AIL�P�.Sa� blv� <br /> PROJECT ADDRESS /�Z7� <br /> )o�- Jacl�5ov. ►-134 �}�v�1'L5dv1 �UIz.�TGI.YJ, Z52 -z�ls� <br /> PropBfty OwnBr Mail Atle�ess C�ry Sla�r.ILp Phone <br /> � <br /> Tenant Name jlf this is!or a commercial bus�ness) <br /> � q,�nr�a..'c-°,^" <<l2�'� <br /> ss nl.�L �� s;dr ��,�w.�2 �bo� �J.a�,:, �o. ��� z�/�l- 94s9 <br /> Contr ctor M1lad ACdress Cdy Stale�Lp Phone <br /> J}iN1��-ISS �B�I fC.l- U535'yE3 <br /> WA State Contractor License Number(requved) City ol Everelt Business License Number(reqwretl� <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer - New Installation <br /> C3 Install Backwater Valve (outside ihe building) <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meler <br /> FEE <br /> ��1D ao <br /> `� " � � � S PERh11TN <br /> Date � 1�I I / ` � I <br /> V <br /> AFviSEO�Ir+94Ju <br />