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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 —www.everettwa.gov <br /> � � ^ G�'C �'������ <br /> , <br /> � � ?/- �' ��Ci ��i �1 � � <br /> PROJECT ADDRESS <br /> �7 �� � ��C � � �� � � � � � <br /> - � � ��' �"�G� �'�.1j' C��f�C���� <br /> Property Owner Mail Address City State/Zip Phone <br /> �,���,Z � <br /> Tenant Name (If this is for a commercial business) L/���%,_ ��_ j� � �'�`: ,� �/`���,� . <br /> , ��i .�e! �`�%C�.���� 7i�t:���f, � �C'�`,��; % �'/�.j ' � � �-' �'` /�/� <br /> �- . -� �i � <br /> Contractor Mail Addr ss City State/Zip Phone <br /> � ,� r., � <br /> /-� /�/ � Cti �7 �- / ��<<-f� � � �� ��' �-� <br /> WA State Contractor License Number(required) City of Everett Business License Number(required) <br /> Work to be done: <br /> KY�ide 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 l <br /> FEE <br /> �--- <br /> � � .---- '.�'� ./ <br /> lr- r <br /> � � �-� / � /� <br /> � _ PERMIT# <br /> Signature Date � �,✓��J �)�,e <br /> �� !_.j <br /> REVISED 11/19/2014 <br />