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WATER/SEWER UTILITY PERMIT APPLICATION <br />CITY OF EVERET- PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, VVA 98201 <br />425-257-8810 - FAX 425-257-8857 — wvnv everetMa gov <br />_ Z l 0� 2-4 `b <br />PROJECT ADDRESS <br />Property Ov+ner Mail Address C,ty <br />Te ant Name (1t tnis is for a commercial business) <br />Cad Andress any <br />r` <br />Alil/lFEW IS'Sr � / L <br />WA Stale Contractor License Number (required) <br />Work to be done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />U Install Backwater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />Slate/Zip Phcre <br />C1(2:G) <br />Slate/zip Phone <br />l o"�- i �GC J <br />City of Everett Business License Number (required) <br />t - iU -- ("5 <br />FEE <br />?)0,�� <br />PERMIT # <br />U1511-0 tI <br />REVISED 1 iR9/IOIa <br />