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, ' <br /> UTILITY PERMIT APPLICATlON <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 -www.everettwa.org <br /> 3 l o `�1��> ��� r�a,�= <br /> PR JECTADDRESS � � IO— <br /> �, ��-��s Saw�e. �. g�� ��d I� <br /> , <br /> Property Owner Mail Address Ciry tale/Zip Phone <br /> ! ' <br /> Tenan ame (If th s is for a mmercial business) O�ji - <br /> �b�lule. ��� �6s- <br /> r��� � a3 a����s�.s w �c���� �A- ���� y r�� <br /> CoMraCtOr Mail Addiess � CAy St e/Zip Phone <br /> � o�SS �r t ,S ��� ��C7 <br /> WA State Coniraclor Licens M mber(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 /> � Install Backwater Valve (outside the building) <br /> ❑ Cap off Sewer <br /> C� Install Water Meter <br /> FEE <br /> �` �� '�(��� 3� <br /> PERMIf# <br /> n ure Date 1 t I �O�_ O'"j� <br /> U � <br /> REVISED 11/19QOla <br />