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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 - vnvw.everettwa.gov <br />� g� 1 �,��- �s � <br />PROJECT ADDRESS <br />ProPerty Ov:�r 4;a��.i ndzress <br />� <br />, Tcnant Nam t(If th�s s!or a ccm�t�erci2! business� <br />/4-�'�n. e-t2 i �-c�.+t/� <br />� S�ti'`c G..I.�L-i J�� o�L� ��,ccJr.tL r��� � <br />I Con raefcr ',t;ar,l.tl�ress Ctly <br />' !�-w1 �i2 i 5��61 �� <br />�, WN State Conttaaor L¢ense Numoer (reqwred) <br />� <br />� Work to be done:' <br />III ❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />Cl Install Backwater Valve (outside the building) <br />❑ Cap of( Sewer <br />❑ Install Water Meter <br />�.vc <br />c�ry <br />i �� <br />7 � - � Z%� <br />S;alc!Lp Phonr, <br />DS�SY� <br />City o1 Everett Pusmess License Number (reqwretl) <br />� -- � s- �s <br />�� �ig ,v�e —t� � �ote <br />� <br />I <br />FEE ,^ � <br />,c� ; v� <br />PERMIT�---, <br />��I ��l�� <br />