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UTILITY PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — wvuw.everettwa.org <br />�ll ��� 1In�� <br />PROJECTAUDRESS <br />Owner <br />IZfG <br />Meil Addiess <br />Tenant Name (If this is for a cammercial business) <br />City <br />(�12�� <br />z6S - Z 5 (1 <br />SlalalZip Phone <br />ConlfaCtOf MailAtlaress ""+ - <br />/�M� 5�6� K� <br />WA Slale Contractor License Number (reqwred) <br />Work to be done: <br />❑ Side Sewer F2epair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />E7 Install Backwater Valve outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />aEvrsEo tinaac�a <br />�ti 3 �� 4'f3 <br />City of Everefl Busineu License Number (require� <br />3-2.�-�s <br />FEE <br />30°� <br />PERMIT# <br />u � 503 - I� q <br />