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� <br />� <br />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 />� ~ J � � -� "�ti v1�-�_ <br />PROJECT ADDRESS <br />`� i'Y1 � � �'l �J '(��' � �� �� � L� � -`� Y`''t C' i!� �'1/-�- <br />Property Owner Mail Address City State/Zip <br />Tenant Name (If this is for a commercial business) <br />�� ����'��� ��� <br />Contractor � Mail Addr <br />��.� �;)( v/ -�� r/J�/� <br />WA State Contractor License Number (required) <br />Work to be done: <br />�� <br />Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer— New Installation <br />� �� �, � Jt�_.����v2«�_ �t�''� <br />C� <br />ity <br />❑ Install Backwater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />-� <br />� <br />Signature <br />REVISED 11/19/2014 <br />-� <br />��2 i `�<S�� �' j <br />Phone <br />� � [��;' � �-��/�z <br />State/Zip Phone <br />/ � J� >�� <br />City o Everett Business License Number (required) <br />�' <br />_ `������ <br />FEE <br />-��,�,o <br />PERMIT# <br />U (C� I C� � i� �� � <br />