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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 />5 t © AV(:, <br />PROJECT AL .RESS <br />Pr^L,l All0.rCL <br />Property Owner <br />Mad Address <br />Tenant Name (If this is for a commercial business) <br />C try <br />AA"Lj'iC V� ' 5rvwer- i, '?917- tQ6t4 S4 IJG <br />Contractor Mad Address City <br />p" P"v%i SC.0T <br />WA State Contractor License Number (required) <br />Work to be done: <br />Side Sewer Repair <br />❑ Side Sewer Alteration <br />\ 0/ S de S er N Inst a on <br />Install Backwater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />Nov -2/f 5 <br />State/Zip <br />State/Zip <br />OS14 s`i3 <br />11153()5!55 <br />Phone <br />1-115 zGR ZK+ld <br />Phone <br />City of Everett Business License Number (required) <br />FEE <br />ZIT# <br />1kND <br />REVISED 11/19,7014 <br />