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•I_.—. <br /> WATER/SEWER UTILITY PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-881 U - FAX 425-257-8857 —w�w�.everettv�a.gov <br /> � , � , � ��A � G ��v3 I� <br /> �I � 2 � (�� I1p �� ��`��E�.-r <br /> PROJECT ADDRESS <br /> � �n/�- ��n[�C� S �)c�Z `I ClI �l�P � Sl�l9l�— ((�''���✓1�9, 9 6 ��� <br /> � PropertyO�vner 1.taJ;.Cdress Gty SWtc¢�p Pnone <br /> Tenant Name(If th�s is for a commerciai business) ���' 7(�3'y�z <br /> , t� s���rP/U�,�;� � � l�c�� zZZ�� n���,n-�/a�k�.e�-��c� (��9 � s�'a� 6 <br /> Coniractcr Ltad aca css Gty Sta;c�Z�p Pnuo� ; <br /> � 1— I S� � (�L � 3� � 7 �3—� <br /> I WA State Gontratlor License Number(reqwretl) Gty of[verett�us� ess L¢ense Number( equ�rea) I <br /> ��, � �� � ��,1� � -p��� p���- <br /> - , -, <br /> � `Nork to be done: -�`1 � �L <br /> � <br /> C��ide Sewer Repair � �� <br /> r , �� <br /> ❑ Side Sewer Alteration <br /> i <br /> ❑ Side Sewer — New Installation <br /> ❑ Install Backwaler Valve (outside the building) � <br /> ❑ Cap ofi Sewer <br /> ❑ Install Water Meter <br /> FEE <br /> �30.� <br /> PERh1ITrc <br /> Sign,lturc DOIC � ����� /���� <br /> �� <br /> u. .s�ir�i;�o�: <br />