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. <br />WATER/SEWER UTILITY PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STR�ET, EVERETT, WA 98201 <br />425-257-88� 0- F�1X 425-257-8857 — www.everettwa.gov <br />I a I 2 1-%e,�l �" f�Y �_ <br />PROJEC'T ADDRESS <br />i'�" <br />Property Owner <br />Ma€I Address <br />N-e�r ��S Lg ��a F� r tn <br />Tenant Name (ff this is for a cammercial business) <br />City <br />Stafe/Zip <br />� <br />Phone <br />M�. R�k�r Plu..mbi na 2Do0 5- I I Co�'S-i' cSecc.-�-te CJ 9gl�v% �pa- �os'� 2R/7 <br />COntractor Mail Address City Stats/Zip Phon� <br />mQ�.Qh�-� �i� <br />WA State Cantractor License Number (required) <br />Work to be done: <br />5� Side Sewer Repair <br />�� oa <br />City of Everett Business License Number (required) <br />�� � <br />� <br />C] Side Sewer Alteration �► " l>-" . <br />� �� j� )�(�. <br />f �-�J' <br />p � CJ`' `� , <br />❑ Side Sewer -� New Installation � � �('�� �, <br />� � ��,� <br />l � <br />❑ Install Bacltwater Valve (outside the buiEding) � � f�D � <br />p Cap off Sewer <br />❑ Instafl Water Meter <br />u <br />REVISED 14/'+9/1014 <br />� � <br />�� � <br />C ��,� <br />�; � � <br />C �� <br />� <br />�� a � <br />�,2 <br />rn� <br />�� l� <br />FEE <br />���� <br />PERMIT# <br />U I�I. C���� <br />Z,ti:a6pd LS88ZSZSZbti��l :wo-�� 00�9ti StiaZ-6ti-1�0 <br />