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- WATER/SEWER UTILITY PERMI� APPLICATION I <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 �EDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 - www.everettwa.gov <br /> 2�v 5 Z3,¢-� �-�. , <br /> PROJECT ADDRESS ���ZS� I <br /> �+�1 �aMc.�.,LL Z�oS z3�d �T �V'�•2�Gf �.� a � �'9 � - 10�0 ' <br /> PropeA Owner Maii Address Gty � SIa�e2ip Phone <br /> � <br /> Tenant Name Qf this is for a commercial business) <br /> �N,i.�2i'ca,�.,. ��{Z;� <br /> I �; '�e�.�p,Q 26Q� L-�c��., r�r��U�P-�Eri a �Y�l- 94� <br /> Con actor MailAOdress C�ty S�aie/Zi Phone <br /> �U�I,rc.Q.l SS 8 6 I ICL. DS'� 5�l�,3 — <br /> WA Stale Contractor Llcense Number (required) City of Everett Business L�cense 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 /> FEE <br /> � ���, 00 <br /> � {U Z�" � S PERMIT# <br /> Date 1 I I}�i O_ f,�� <br /> U '"J � U <br /> REVISED 11It9QOfa <br />