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WATFR/SEWER UTILITY PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-E1810 - FAX 425-257-8857 - www.everettwa.gov <br />�10 �l 6,-�� �I �� �,� o��..-�f <br />PROJECT ADDRESS <br />Pwperty Owner <br />�S ( 5aa�� <br />Mdil <br />Tenant flame Qf th�s is for a commeraal business) <br />I j \ 1K � �i, <br />Contractor t.lail Addre;s <br />CAr�P,�PI�/7j'►�S <br />WA Siate Contractor L�cense Number (reqwred) <br />Work to be done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Si le Sewer - New Installation <br />Cdy <br />f9' Install Eiackwater Valve (outside ihe building) <br />❑ Cap of( Sewer <br />❑ Install Water Meter <br />Ciiy <br />StatelLp <br />SlalcrZ�p <br />Phone <br />Pnone <br />D�t�7o3 <br />C�ty ol Everett Husmess License Numb��r (required) <br />`��'��o�� �/" /3/l.�- - <br />s����:�i���„ i,.�i, <br />r,.or.to,vi,,;,i, - - - -- — - - - — <br />FLE I <br />��.� °� <br />PERMITX <br />U 1��-ol�j <br />_ _� <br />