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� � WATERlSEWER UTILITY PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3?.00 CEDAR STREET, EVERETT, V��A 98201 <br />425-257-8810 - FAX 425-257-8857 - vnv�v.everethva gov <br />33b2 <br />-�-� ��� <br />�. <br />PROJECT ADDRESS <br />fOpCf^/ �l'+f1Cf <br />'.1an Adtlress <br />Tenant Name (If this is for ayqmmeraal bus�ness) <br />I��.��lJ�-��:.�-�1- `�'� °�' '� <br />/v�V1'1�.��,1i�) lu1�n <br />ICCnlractor '.1aAFdtlress G;y <br />S �'L�S� �� 3 K� <br />WA Stat? Cc^tractor t.�cense Number (requ❑edl <br />Work to be done: <br />❑ Side 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 />City <br />SlalelZip Phone <br />Slatc2ip Phcne <br />L' l / !l (/ � <br />Gry of Everett Business License Number (reqwred) <br />REVA[01 V�9n,p�a <br />FEE <br />2JC �� <br />PEf2MITk � <br />U �"✓1�-�-Ikj <br />