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UTILITY PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8610 - FAX 425-257-8857 - vwvw.everettwa.org <br />� �2 co�6, <br />PROJECT ADDRESS <br />�� <br />/.�/ /,L .>��6 >`� � 3 2 �'c ��j- / /���C �i..t r�t � � C✓d. `lg%�' � <br />Property Owner llail AEdiess Gty Sta'e2�p Phone <br />Tenant Name Qf �h�s is for a commercial business) <br />/%�.,•.f�l���es;�s 96o,,.r..��J.�„� F ,vtrl�o., !✓� ���% gggz�37�S� <br />CoNractor Mad Adtlress C�ty State2p Phcne <br />S�l✓Fiz TL �97 .t� � <br />bVA State CeMractor License Number (requ�red) <br />Work to be done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer - New Installation <br />�Install [3ackwater Valve (outside the building) <br />O Cap off Sewer <br />❑ Install Water Meter <br />n��v5E0 nnY:ola <br />OS6 ��% <br />City of Everett Business Ucense Number (reGuired) <br />�70 �� <br />PERMIT# <br />U l50(-�0•� <br />