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WATER/SEWER UTILITY PERMIT APPLIC,ATION <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 /> (� ( Z Z� `J�' <br /> PROJECT ADDRESS Cy p�) <br /> �u4a^ 2aDGS�Z ��lZ 2S'�'S� lz,l��f�77 wC� , �� •�OYv7 <br /> Pr�pOrt Owner ldad Address Ciry State/Lp Phone <br /> � <br /> Tenant Name Qf th�s is for a commercial business) <br /> f}�v�,�".er C.� ��ZS� <br /> ��n�,'� ,� 5���l Sew�,e 26� C.�,�l,., c�. �UG�� 2�y- 9Qs( <br /> Con �act0� P.1ailAtldress Ciry Stale/Zip Phone <br /> A-w��� sS � �� f��-- C�5 3 5��' <br /> WA State Contractor License Number(req�rted) City of Everen Business 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 ihe budding) <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter <br /> FEE <br /> ^ � �O,O� <br /> �� %� <br /> U — `� — l� PERMITA <br /> gna r Date 1 1 ��� �' q ^ , <br /> U U �� <br /> REVISED II/19R0�4 <br />