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WATER/SEWER UTILITY PERMIT pPPLICATION <br />CITY OF EVEP.ETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — vdvnv everetiwa.gov <br />� ��� /� -� <br />�, PROJECT ADDRESS <br />� . �c1 <br />��, CFl�iS i�z2�rne� ��o.� �'' �il�� <br />'� Prope��yOwner t.ia�iqdaress G�ry <br />�. <br />�I Tenan; Name (If Ihi; is for a commercial busine55) <br />�I �-�vt'P.✓Lt� C«M <br />5-eQ��c r,=.,.� �.l �, ��l P.See,�., ecz �� ��l, u <br />I COnt BCtOr �!ail Fddress ��ty <br />�' �SS'.�� �l,-� <br />, LNA St�!e Contractor License Number (ieouvedj <br />I� Work to be donc: <br />I ❑ Side Sewer Repair <br />❑ Side 5ewer Alteration <br />� ❑ Side Sewer — New Installation <br />Q" Ins,all Backwater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />PEvrFCn � vw2oi< <br />Sta;e2 p <br />C�� <br />�7`%- �/2£� <br />State2ip PnCnc <br />City oi Everett f3usin?ss L�cense Number (reqwred) <br />FEE <br />�-�� o0 <br />� <br />r�ERr�irrr <br />u I � 1 ��6�1�� <br />