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.�, <br />UTILITY PERMIT APPLICATION <br />CITY OF EVERETT RERMIT SERVICES <br />3200 CEDAR STREET, [VERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />� �� �� �L�G� � <br />PROJECT ADDRE3S � <br />Owner <br />1Jail AdCress <br />Tenanl Name Qf this is f�r a commerc�al business) <br />CoNractor � 61a�i <br />��� /��i� �/� <br />WA State Contrector License Number (required) <br />Work to be done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side 5ewer — New Installation <br />Cily <br />Install Backwater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />pEVlSEO f i/t?ROIa <br />Cdy <br />SIa�C/Lp <br />SlatelZip <br />Phane <br />1 `�r �(�� <br />�� � <br />l <br />Phonc <br />l%S� $ J� <br />City of Everetl Business License Number (reqmred) <br />FEE <br />�OO� <br />PERMIT# <br />U150Co'O1� <br />