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WATER/SEWER UTILITY PERMIT APPLICATION <br />� ClTY OF EVERETT PERMIT SERVICES <br />3200 CEDAR ST�FET, EVERETT, WA 98201 <br />425-257-8810 - F/1X 425-?5%-8857 - w�.�-:+.everettwa.gov <br />Z�l/ G2-��; <br />PROJECT ADDRESS <br />Property Owner <br />L b// <br />h7a�� 4dtlress <br />Tenan; Name (If lhis is for a commerual business) <br />,Q�.��l ��M hI � �� � o� <br />Contractor �.�a�iAatlress C1ry <br />� o�/��'� ,n �1 � <br />WA State Coc;ractor' L�cense Nu ber (re ��red) <br />f}'� t��P/ 90 3 �T <br />Work to be done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />� Side Sewer - New Installation <br />City <br />Slate1l�p <br />Phonc <br />�i j � ,� �v /�^;� �.�-�'�./ % � <br />Slale�Lp /� Phone <br />Gry of Everett Busmess Llcense Number (requ�red) <br />�� � 2 G✓� �-� <br />❑ Install Backwater Valve (outside the buiiding) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />l <br />nr:,sn� niwraw <br />UG � <br />FEE <br />�O 00 <br />PERMIT;, <br />U �� ((� -0/D <br />v <br />