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WATER/SEWER UTI�.ITY PERMiT APPLlCATION <br />CITY OF EVERE-I T PERMIT SERVICES <br />3200 CFDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — wvnv everettwa.gov <br />�, h l ���cke.� ll �i- �•c , Eue�2�t- �� I <br />PROJECT ADDRESS <br />�o2d-S�u��a Z!<S i7P,3Z�/oh/Ic�.vC�Ga�� F�sf,�vl.�, c.�/a98�SS� ����9�/•67�7 <br />PropertyOwner MaO�dtlress Ciry StateQip �'��e <br />Tenanl Name pf lhis is for a commeiaal business) <br />�/zs-C7G �IoS- <br />JiviZC'0,4����7o�LS,�c� ��g3z `f�j+� Au�Nk Lo(�eFr�i'�1N�4/.a 9B/SS <br />Contractar Pdait�dtlress City Stafi2�p Phone <br />s"MZCvcL�58PR <br />WA State Contractor License Number (required) <br />Work to be done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />� Install Backwater Valve outside the building) <br />❑ Cap oft Sewer <br />❑ Install Water Meter <br />REV6ED f V19?Ofa <br />Os�891 <br />C�ry cf Everett Business Licensc Number (requ�red) <br />Ir " ✓/� <br />PERMiT� <br />u 1511-015 <br />