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UTILITY PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET , F VI-RETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everellwa org <br />,27E)i kt&- DOq 36 I o2,20010D <br />PROJECT ADDRESS <br />Properly Owner Mail Address City <br />Tenant Name (If this is for a commercial business) <br />Contractor Mail Address City <br />�,,4C6: iI 6)5- N to <br />WA Stale Contractor License Number (required) <br />Work to be done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />❑ Install Backwater Valve outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />stale/7qi Phone <br />1'T�Cr�I r dr./CsIV% t�I[ / (J <br />Slald7.ip Phon <br />City of Everett Business License Number (required) <br />I-EE <br />a; <br />PERM l <br />