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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 425-257-8857 -wvuw.everettwa.org <br />�,1� -� f��� ��� <br />PROJECT ADDRESS <br />Property Owner <br />Ma�l AdCress <br />Tenant Name (It this is for a commercial business) <br />�N <br />Contra[1of Ma�l Address <br />�l�.�i �� S3� � K � <br />WA Stale Contraclor �cense Number (reqmred) <br />Work to be done: <br />O Side Sewer Repair <br />� Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />-c{ r�lQ, `[f�l ( 2�,��� <br />City SlateZp <br />� �-125� <br />" � i,l i,v 0. �( i� �� .�..v � -- �i' <br />Ciry StatefLip Phone <br />E3" Install Backwater Valve outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />aeviseD rtnsaoia <br />P�ono <br />5 <br />C�`� 3 °J �lP� <br />City of Fverett Business License Num6er (reqmred) <br />FEE�oO� <br />� UI �O�-l(C7 <br />