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WATER/SEWER UTILITY PERMIT APPLICATION <br />CITY UF EVERETT PERMIT SERVICES <br />°200 CEDAR STREET. FVFRETT, WA 9820� <br />425-257-8810 - FAX 425-257-8857 - www everethva.gov <br />I �" <br />� ,��.' d � ��%'%�!�/t�f e _ //!� <br />IPROJECT ADDRESS <br />! _��t� �%!��'�iG� <br />�I Propehy Owner ttac �daress <br />I <br />��, Tenan; Name ilf ;his �s fc� a commernal bus�nessl <br />� <br />co�,ua�m� <br />IACCress <br />'� ./-��`'t" �l_ (/� .,K �//�'r� <br />, <br />I WA S;ate Ce•�t�act�r License ��'um�er (requ.red; <br />i Work to be done: <br />� ❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side 5ewer - New Installation <br />< <br />c::y <br />f�lnstall Backwater Valve outside the building) <br />❑ Cap otf Sewer <br />❑ Instail Water Meter <br />� .. . <br />,, - - <br />c�ry <br />Slatc2p Phone <br />�l�s- �`a�� �I <br />`. <br />-,� f ����s` <br />State2��.� Pno-r <br />� �-�'f S�� <br />Ciry of Eve,et; Bus�ness License Number (requ:red) <br />���s ��n�-f�'�cfi� <br />���s� �L �� <br />h�t �fG�u <br />�!'w � <br />� 30�� <br />ree <br />���, �� <br />PERP11Tr - — � <br />� i50� �0�0 <br />