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WATER/SEWER UTILITY PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREL 1. EVERETT, WA 98201 <br />425 257-8810 - FAX 425-257-8857 - www everettwa gov <br />PROJECT ADDRESS <br />Property Owner <br />f: a Addres <br />Tenant Name (If this is for a commercial business) <br />Contractor Ma I Address <br />VJn St a Contactor LiCenSe Number (required) <br />Work to be done: <br />ySide 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 />CAy <br />Ui S/o—Dyl2 <br />10—'a'o-IS <br />Sta'e2 P <br />W(o <br />r' O9e <br />5tste1zPP Phone <br />City of I .erett Business L terse Number (req ared) <br />FEE <br />l o :En _� fS PERMIT« <br />Date U 1 r 1 !n p <br />nNMrn f 1119?04 <br />