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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 - �wnv.everethva.gov <br /> �S�I �c5�cn7 ��,e I <br /> PROJECT ADDRESS <br /> cw,,-�c„ �/o,es <br /> Property Owner Maii Aaoress Cny Slale�Zip Phone <br /> ITenan; Name Qf this is for a commercial busmess� <br /> i ? <br /> I P�KU/ Tc % d�1S S IJ'�f4 5T SC_�..G LN GI SSl,�O �1�I'��7'��OJ <br /> ConlraCtOr MadAdoress Gry S;ile!Z�p Phone <br /> PRTL �TL86� kZ o53� 41 ' <br /> �I WA Sate ConVactor L�cense Number(reqwred) Gty of Everett Business License Number(requued) <br /> iWork to be done: <br /> � Side Sewer Repair <br /> � ❑ Side Sewer Alteration I <br /> i <br /> ❑ Side Sewer - New Installation <br /> ❑ Install Back�vater Valve (outside lhe building) <br /> ❑ Cap off Sewer <br /> ❑ Instail Water Meter <br /> FEE <br /> �� �0 <br /> ���/ .� �I/�/�J PERh11Tk <br /> S�gn ure Dale 1 , � � � / �Q J1� <br /> u � v <br /> REv�5E0�v�?qota <br />