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�� <br />� <br />WATER/SEWER UTILITY PERMIT APPLICATION <br />CITY OF EVERETT FERMIT SERVICES <br />3200 CEDAR STR[[T, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — �wrw.everethva gov <br />� 6Og' �ot��E/%i� /��.�e� �i^�reN; l.�,A `l'�2.v1 <br />PROJECT ADDRESS <br />2f,3o Sw l67�~ L <br />!�k�'/';Gk /%1. F Sa /�n� S. f�C''I�'1'�rin Tr45� 13a��e�, wA 98/6� <br />Property Ov+ner <br />i;�d i f�dtl�f55 <br />Tenant Name Qf lnis is fCr a cemmerc�ai bu5��essj <br />c.ry <br />Sta;elZ:n Pnone <br />ti Z5 �7G-73os <br />y6�,s� <br />j �v1 Z Cc�dr4cl��s,�LLC i�ti32 �lota,�{ve N� Gc,kE. vresf l� i u,4 ; <br />Cont,acto� '.la�l�daress ��;y State�Zip 'r�o^�e � <br />Tr� Z c vc� �,s P2 <br />W� 5ate Contrartor License Number (reqcired) <br />Work to be donc: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Instaliation <br />� Install Backwater Valve (outside the building) <br />❑ Cap of( Sewer <br />❑ Install Water Meter <br />. _ ; ,.:., <br />o�ti�9� <br />Ciry oi Everett Busu,ess L�cense Number (reauuedl <br />/U-3t�— �� <br />F[E <br />���. �0 <br />PC-RMIT� <br />u151I-Do3 <br />