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UTILITY PERMIT A��LICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.evereltwa.org <br />� � � COL 1, ' �9-�, <br />PROJECT ADDRESS <br />Owner <br />Address <br />Tenant Name (If this i� for a commercial business) <br />� 1 /� f � � . �� , <br />Mail Address � <br />Work to be done: <br />❑ Side Sewer Repair <br />O Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />�nstall Backwater Valve �outside the building) <br />�� <br />❑ Cap off Sewer <br />O Install Water Meter <br />REVISFD f f/19n,pfa <br />Cily <br />UVr1 <br />StatelZip <br />Phone <br />��� <br />Phone <br />��� — UVV <br />City of verett Business License Number (required) <br />FEE <br />��o,°� <br />��� � PERMIT# <br />u 1��'��1y3 <br />