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� <br />WATER/SEWER UTILITY PERMIT APPLICATION <br />CITY OF FVERETT PERMIT SERVICES <br />3200 CEUAR STREET, EVERETT, WA 98201 <br />425-257-3810 - FAX 425-257-8857 -- v,�ww everethva.gov <br />a b 2i �v ��d'alle.. �u�.., Fv-v,�.et� wr� 98 zo � <br />PROJECT ADDRESS tf2r 9'`�J..� Jlr ; <br />. . _ , _� <br />Sce �l �+r�.,,w Z/y�, 17�32 4d���e.. NE ,�,alc.� fo�SD� �`vL, t✓A `%£ f is <br />Properly 0vrner t.taa t.daress G;y StatelL� Phonc <br />?-eran; Name Qf ;his �s for a camme!aal business) <br />�rn � <br />ConVaclor <br />ConFrQ��oES, (.LL <br />'.1. I f.tlriess <br />� T/►'�ZCOCC.�SPl2 <br />IWA State Con,rador License N�mber (reqmred) <br />Work to be done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />�Z 'fo�.t��c <br />Gry <br />� Install Backwater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />r 1�2-� 5 <br />FNbCO nni^or< <br />La <br />S!ale!Lp <br />y2 S- A'76-7�GS- <br />s3 P�v�rr►A 98iS3' <br />Pnone <br />oSy89! <br />City of Everetl Busmess License Numbzr (reqwretl) <br />F[E <br />PERMff;. <br />u ►5l I - DD� <br />