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WATER/SEWER UTILITY PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 C[DAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — vn+nv.everettwa.gov <br />( 1 �� C�--�C 1`—�/� . <br />PROJECTADDRESS <br />� �''� <br />P [ � �.-, � a ��.� �. / `F7 �� 1 � <br />Property Owner <br />nadress <br />Tenant Name (If th�s is for a commercial busmess) <br />FI-r4-Pl �,-� � i v�a, L� L d�/o �� <br />ContratlOr IAail A4Cr 5 Qry <br />�/,, ,�a���/.� <br />WA Sta[e ConGactor License Number (requrtetl) <br />Work to be done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />�all Backwater Vaive (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />REV4ED t1/19n01J <br />Ciry <br />� <br />Tl2/ LSb-- <br />Slale�Zip Phone <br />� g 9- o�le� <br />Stale/Zip Phonc <br />l`� � �� . <br />Ciry of Everett �usmess License Num9er (requued) <br />(� —^�--- 1 � PERMIT� <br />e u i b I O�G°I <br />