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WATER/SEWER UTILITY PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 982C1 <br />425-257-8810 - FAX 425-257-8857 -- wvNv eve;ettv:a gov <br />ZI1� G-V were-k W), g92-0 <br />PROJECT ADDRESS <br />Property Owner Mail Address City Statelzip Phone <br />Tenant Name (If this is for a commercial bus;ness) <br />110 V�..t!nbtrY 54tsj �15�Y�,P �I�, M�rt�sy�ll� �� g8Z7o YD�3�-le <br />Contractor .ail Andress GPl Sae:L; Phone <br />W-? 0L-I- J-9 D 3 1,T _ <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 off Sewer <br />❑ Install Water Meter <br />City of Everett Business License Number (required) <br />FEE <br />it" 30,o� <br />-1 t� PERMIT# <br />U 1510-003 <br />RrVISED IIIr9RON <br />