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WATER/SEWER UTILITY PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, VJA 98201 <br />425-257-8810 - FAX 425-257-8857 — wow r everettwa.gov <br />PROJECT ADDRESS L(Z.SJ <br />Jct5w;r� wuA� j 3Y10 1)dLC5- glJaZltlah, 530- g166 <br />I'rcpe" ; OAn•.• Mait Aaaress CO, <br />lan�a�-i: �-Narne (It this is `or a emmercial business) <br />� "= S �de5er�e 26c L $rzl, . �tl� �1L� r ZyY- <br />Cc•'Ir 9Q5 <br />la' Earl Aaaress ::pry Slate/Zi Prcre <br />A-tM.'Ce;55F3hl K(_ 0,535`i 3 <br />WA Stale Contractor License Number (required) City of Everett Business License Number (required) <br />Work to be done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />Ne<nslall Backwater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />30°0 <br />q .2? t S rYIC-67— <br />Vrr,4 <br />Date —D-� I <br />RB9SEU rVrS :Or4 <br />