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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 — www.everettwa.org <br />�J� Y ` — <br />PROJECT ADDRESS <br />Pmperty Owner <br />b1aA ACdress <br />Tenant Name (If this is for a commercial business) <br />� S� �,��� �c a� <br />COnlraCtor Mail Address <br />�.�i �� 53�� K� <br />WA State Contraclor License Number (required) <br />Work to be done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Installaiion <br />City <br />H" Install Backwater Valve outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />nEvisev ��nvtoi. <br />Ciry <br />(�:�) <br />�� �o/ - <br />Slate2ip <br />(425% <br />��a�3 �4� <br />State2ip <br />Z!'�Y <br />P�one <br />Phone <br />5 <br />�73 °��(8 <br />C�ty of Everett Business License Number (required) <br />FEE <br />3v°° <br />P[RMii'!J <br />u c�o� — i�r� <br />