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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 — v�nvw.everettwa.org <br />�`Z�0 �Q��S� Rvd �VE�`t'? �R <br />PROJECT ADDRESS <br />��cllAao Hip.WS �tile Co' �4� Avs <br />PropeAyOwner Maiiqddress <br />Tenant Name Qf this is for a commercial businoss) <br />�1°v1.� I <br />Ev�'r� <br />City <br />�1�R.o Pl.vM4,•�- �''� �nx �i4�1 S'ro , <br />Contractor Mail Address Ciry <br />u� ev�ec�sNi <br />WA Slate Conlraclor License Number (required) <br />Work to be done: <br />O Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />L9'Install Backwater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />IZ/4 / if <br />w� . <br />StatelZip <br />w-� . Fs 2'► � <br />StatelZip <br />S$� � <br />Phone <br />'�(s �Fo�� 0 929 <br />Phone <br />o�)33s <br />City oi Everett Business License Number (required) <br />FEE <br />�� <br />PERMIT# <br />U I`ilz-Oz`-� I <br />