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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 425-257-8657 — www.everettwa.org <br />�390 °/ ��r2i¢L ,�-✓� <br />PROJECT ADDRESS <br />� �u �I 39e `r F���,���r� �� J <br />Property Owner <br />Matl Atldress <br />W �/� <br />Tenanl Name (If this is for a commercia� business) <br />�o,���Ce�s%� j�� <br />COnlraC�O� M;il Adtlress <br />9i f-`, <br />C�ry <br />t`�laNcGS a�5- /�(s-�� - <br />WA State Conlractor License Number (required) <br />Work to be done: <br />Q' Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />�L] Install Backwater Valve outside the building) <br />� Cap off Sewer <br />❑ Install Water Meter <br />REViSEO I V19R0�+ <br />c�y <br />�'- �.��-- �"j� � <br />� L <br />St:de/Zip <br />Phone <br />y�s -�z�7yO <br />tila l� iT�'�/�/�� 1�11"/��Z' <br />Slate/Zip <br />Phone <br />��s�l�% <br />City of Everett Business License Num6er (required) <br />FEE <br />3 �00 <br />PERMIT# <br />UlS�s-�7�5 <br />