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UTILITY PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - �AX 425-257-8857 — www.everettwa.org <br />%�� LvL�� �— <br />,� <br />PROJECT ADDRESS <br />_-r- c/;� <br />Property Owner • <br />�dail Address <br />Tenanl Name (If this is for a commercial business) <br />v <br />CoNrador <br />Cily <br />�y4 ��v l �Q//P� — <br />WA Stale Gontractor License Number (required) <br />Work to be done: <br />❑ Side Sewer Repair <br />❑ Side Se�ver Alteration <br />❑ Side Sewer — New Installation <br />�all Backwater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />0 <br />REVISED �iR9R01d <br />City <br />Stale/Zlp <br />State/Zip <br />L%zG�L <br />Phone <br />._, <br />Phone <br />D �� ) ' Y' <br />City ot Everett Business License Number (required) <br />FEE <br />�j'h <br />��� � <br />PERMIT# <br />U15b��D� <br />