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_ ___ __ ___ _ _ __ _ _ __ _-______ _ _ _____ __ __ ____ _ _ _1 <br /> � WATER/SEWER UTILITY PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES ( <br /> 3200 CFDAR STREET, EVERETT, WA 98201 <br /> 425•257-8810 - FAX 425-257-8857—www.everetriva.gov <br /> � So� I�n� s�-, E u z�e t+� � �+- 48ao � <br /> PROJECT ADDRESS I <br /> ��l�e l��er �soa Prn� s� C-�,�r++ w,� 9�'ao � �o��jL-sv�v <br /> � Prpperty Owner h1aA Addmss Gty Slate�Lp Phcnc <br /> �i Tenant Name (If th�s�s for a commeraal business) <br /> NW Se�c� �-���;n sss7z Po �� �!b���n,� �A �t �Iss— ��� � - y3�-s�,�� <br /> ' Cortractor 1.ta�.l Ade�ess Ciry S;ate/Z�n Pho�e � <br /> N�� spW ��1 s�� P6 (- xn io��li� �S37 �Z <br /> ', VJA Sta;e Cortrador License Number(reQuired) �T Crty of Everetl Busme55 L�cense Number(reqwred) � <br /> i <br /> Work to be done: <br /> I <br /> ❑ Side Sewer Repair <br /> 'i ❑ Side Sewer Alteration <br /> ❑ Side Sewer — New Installation <br /> �I ✓� Install Backwater Valve outside the building) <br /> �I ❑ Cap off Sewer <br /> i I <br /> ❑ Install Water Meter FEE I <br /> �O 0 <br /> � � /Q p� /,� PERh11T« � <br /> Signaturc � Dalc � I� � O _ D�� <br /> rc���5vo,v;.sma _ _ _� <br />