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•�-----.-- -- -- ----- <br />WATERISEWEa UTILITY PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />i 3200 CEDAR STREET, EVi=RETT, WN 98; �1 <br />i h25-257-8810 - F�X 425-257-8857 - wvnv ever .:�v✓a.gov <br />�, �J��� -��a� <br />; PROJECT ADDRESS <br />�openy Ov:ner � l �,ta�i Adtlress <br />� <br />lv � <br />Tenant Name QF th�s is �o� a comys(�al siness) <br />l � <br />�\\�n��ff�{r I�J1 <br />t.tail <br />�J-��� � � H5�'� � <br />WA State Contractor License Number (reqw�ed) <br />Work to 6e done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Se�ver - New Installatioi� <br />Install Backwater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />l�— <br />F�=v{.!-J ' In' :'C;: <br />ary <br />�� <br />State/Zip Pnone <br />1� )� �� <br />Slate�Z�p Phene <br />� `�� �� <br />Gty of Everetl Busmess L�cense Number (required) <br />- :� -� — <br />�J :_ `�� � - � <br />`_ , `, <br />I� OCT2^2015i� <br />I� � � ) <br />�_ . <br />��d��5s � <br />C �,,, Q � Gk, <br />`�v o° <br />PERMITr <br />� 1�10-0 <br />; <br />