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WATER/SEWER UTILITY PERMIT ANPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR SThEET, EVERETT, WA 98201 <br />425 257-8810 - FAX 4?_5-257-8857 - �+nvw.everethva.gov <br />I ,? /, I l ����/�/'w" <br />� <br />I PROJECT ADDRESS <br />Properry Ov:ner <br />LCC - ��83 <br />tdad Adtlress <br />I <br />�, Tenant Nanie Qf this �s for a commerual bus�nessJ <br />Til+ z Co � h-a <br />Contractcr <br />Adtliess <br />� 2 '-f0 �4 fJ'�'e <br />', �rtzcoc�s�2 <br />'i bVA State Contractor License Number (required) <br />IWork to be donc: <br />, ❑ Side Sewer Repair <br />❑ Side Se�ver Alteration <br />❑ Side Sewer - New Installation <br />�°4 /Gr <br />�; /�.�' N� LGl�o ForFs� �✓ ' <br />Gty <br />� Install Backwater Valve (outside ihe building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />FEV;SCD 11: r�?p I a <br />C�ry <br />aGc G'ar'st �!/��, <br />—3-IS <br />St:1Ie/Z�P <br />NZS-9 �!- G7� 7 <br />Phone <br />GZJ•E7G-73o5 <br />S/�S- <br />State2�p Phone <br />OSy 891 <br />City ol Everett Hus�ress l.icense Number (reqwieC) <br />FEE <br />� �O,.�i <br />i�eRrtrr- <br />� 1511-b �3 <br />