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WATER/SEWER UTILITY PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa gov <br />zb(b 20 f,`t- <br />PROJECT ADDRESS <br />I I r <br />Property Ovider I Mad Address <br />Tenant Name (9 tnis is for a commercial business) <br />Contractor Mail Address City <br />L <br />WA Stp.ie Contractor License Number (required) <br />Work to be done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer - New installation <br />Lg Install Backwater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />Cey <br />(uz5) <br />Slaler7lp Pna^r_ <br />Oil, 22&-< <br />slaterZm Phone <br />v53,4E5 <br />City of Everett Business License Number (required) <br />l/-�y-157 <br />FEE <br />PERMII7 <br />REVISED I11"/ 014 <br />