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UTILITY PERMIT APPLICA,TION <br />SS/� Gc/�l <br />PROJECT ADDRESS <br />Oe+ner <br />CITY OF Ei/ERETT PERMIT SEFZVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - wv,�w.everetlwa.org <br />Mail Address <br />Tenant Name p( this is for a commercial business) <br />Ciiy <br />S�ate/Zip <br />Phone <br />/1R�i/�G /�/tin6�r�s f��o7 7�s.��c.rr_ r»nisv,,v t.�/f'Yt�S27� .'�7 CS�7 <br />Contrector IJIa�lAddress City Slale2p Phone <br />F}f�cGLPGS�3 Gi <br />WA Stale Contractor License Number (required) <br />Work to be done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer - New Installation <br />/�stall Backwater Valve (outside the building) <br />� , � <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />FE�95ED � 1/tocaaa <br />�ss y.ss' _ _. <br />City ot Everett Busines:. �icense Number (required) <br />FEE � <br />��� o� <br />PERMIT# <br />� ��n�, o�g <br />