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UTILITY PERMIT APPLICAl"ION <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 />- �tl � L��G�� �t� <br />PROJtG1ADDRESS <br />Property Owner <br />o�-i.G� �1l <br />Mail Address <br />Tenant Name Qf Ihis is for a commercial busines:) <br />Mail Address <br />f�-,���/�J//�i� <br />WA Siale ontrador icense Number (required) <br />Work to be done: <br />❑ Side Sewer Repair <br />❑ Side Sewer A!teration <br />0 Side Sewer - New Installation <br />Gty <br />nslall Backwater Valve (outside lhe building) <br />❑ Cap ofF Sewer <br />❑ Install Waler Meter <br />-- signa�o�c - <br />�a msr.o �vin.•nia <br />� <br />aiy <br />State2ip <br />d-��— <br />�..n'g' �3� � <br />Phone <br />'��d� S—�jZ-� <br />l / �/l,f'�'���- � <br />Slate/Zip Phone <br />��75� ZP <br />Cily oi Everelt Business License Numbcr (required) <br />FEE <br />��� <br />�ERMrru <br />U I �b�3 --1523 <br />