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UTILITY PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR Sri-ZEE ] , I:VI-RI:_11 , WA 98201 <br /> 425-257-8810 - FAX 425-2.578857 www.everetlwa.org <br /> • <br /> 35;Of <br /> PROJECT ADDRESS <br /> Property Owner Mail Address City State/Zip Phone <br /> Tenant Name(If this is for a commercial business) <br /> (1640 t c,',((-1 &vki 9gl i l iee> 103 47/ G' f.' to /97 4 <br /> Contractor Mail Address City State/Zip .�- Phone <br /> L(7> "' 71c. , • <br /> 1 C�->�f°e5 r1(AZ) _d75 <br /> WA State Contractor License Number(required) City of Everett Business License Number(required) <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer— New Installation <br /> Q Install Backwater Valve (outside the building) <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter <br /> It I, <br />