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i:-- - - -- ----- ---- -- <br /> --- - - - - <br /> WATER/SEWER UTILITY PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES i <br /> 3200 CED�R STRGET, EVERETT, WA 98201 � <br /> 425-257-d810 - FAX 425-257-8857 —www.everettwa.gov <br /> /( 0/ �,�er �� fS�c��t,�l�a l��Z�� I <br /> IPROJECT ADDRESS I <br /> �� t> v � n � �R.Yh -e.� - �i <br /> PioP��'�y Owner tdaii naaress Cdy SlaleiZ�p Phanc il <br /> �� Tenam Name(If this�s lor a commeraal busmess) ��I <br /> i <br /> i �'�,��� 1 I`s ��, �,h�.�a ��� <br /> ' Con(taC;o� 1.!aii tiCO�ess GN State2ip Ptm�e , <br /> �� C�1 �M� (� (� i9 � 7r�s Oy77o � <br /> I r^!A Sla;e Contractor icense N�mber (requuedl Gty of Everett Busness L�cense Numbc(reGwretl) <br /> Work to bc done: <br /> I <br /> � ❑ Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer — New Installation <br /> Instali Backwater Valve (outside the building) <br /> ❑ Cap off Sewer I <br /> i <br /> ❑ Install Water Meter I <br /> FE[ <br /> ��, � <br /> I _ 2 S yr/�--� ZZ /.� PERMITx <br /> ' Signawe �� �� �,J I�V ���/Vv I <br /> —J <br /> r:.; ::er�r��a^.�t: <br /> �—__ _—_'_. — _'—_ —--- ' '__—. <br />