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WATER/SEWER UTILITY PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STR[ET, EVERETT, WA 98201 <br /> 425-257•8810 - FAX 425•257•8857 —ww�,v everettwa gov <br /> SIo AlU�erzs�� �1vc1 _ <br /> PROJECT ADDRESS <br /> C�ZS) <br /> �'�n�l l�dl 5'X1� A���,es�� ,t=U�--P�T�L,:�a . �� � �� 7-� <br /> Propehy Owner MaJ ndaress Cdy State/Lp P�onc <br /> � <br /> Tenant Name(I(tnis�s for a commerual busmess) <br /> �L�f�/Li Ga.�.` C�Zf� <br /> 5r��-+c .,,.1 S�cl-e � , .2 >�nF� �rz/. ►. (�R- FU���,uJ�• 2�1�/-94Sy' <br /> Cont ttor Ma�.l AAa�ess Gty Slate/Lp Phone <br /> �wt� �2iS5 S61 �L v53,�y�3 <br /> WA State Contracto�License Numbe�(reQuved) C�ty of Everett Dus�ness L�cense Number(reqwretl) <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> � Side Sewer Aiteration <br /> ❑ Side Sewer — New Installation <br /> 9�Install Backwater Valve (outside fhe buildmg) <br /> fJ Cap o(f Sewer <br /> ❑ Install Water Meter <br /> FEE <br /> �,� 00 <br /> [ � PERMITJt <br /> iq tu� oate <br /> � �51 I-OIZ <br /> REV6F0����9:01J <br />