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� <br /> ; <br /> . .''. <br /> — — - -----I . <br /> WATER/SEWER UTILITY PERMIT APPLICATION ' <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 C[DAR STRE�i. EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —wti•nv everettwa gov <br /> (J i5/o—O yy <br /> 70��1�15 <br /> �_� � � �o�� .�.�t(�,� �!-ve <br /> �I PROJECT ADDRESS <br /> I P�ad�� ��,��n� � reux 5a�-,�e. �i�S- 3f<o-?�75'" <br /> , PropOhy Owrer tdad AdCress CAy State2��p Phone <br /> Ilenan;Name(Ii Ih�s is lo�a commerual businessj ; <br /> I r'�o�',.,� L5� ('oDo� a t� ��" 5�- �(n/ 1--.��n�1 �✓l�- �1��j �(��i-7`%��-�S i II <br /> � ContractCr 1.'�ail Adaress Gty 9ate.'Z�p Phone I <br /> �`�v�-� ���� 33afi�T 053�a�� <br /> WA S,ato Contraclor License Number (requnetll Ciry o(Everett Busines5 License Number (reqwred) <br /> � Work to be done: <br /> � Side Sewer Repair <br /> i ❑ Side Sewer Alteration <br /> ❑ Side Sewer - New Installation I <br /> ❑ Install Backwater Valve (outside the Luilding) � <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter - <br /> FE[ <br /> �� p� <br /> �0-aj.�(� PERh1IT« <br /> Signature Daia � '�I O _ ��rL <br /> _� <br /> FEwsEJ n;�9�ou <br />