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UTILITY PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETf, WA 98201 <br />425-257=8810 - FAX 425-257-8857 — wuvw.everettwa.org <br />3'� �7 �w,� A�� <br />PROJECT ADDRESS <br />I:urk 3�1v� c�2 9� Fn.r�c,df� l.✓� a�c� �6 S��rE <br />Property Owner Mail Address Cily StatelZip Phone <br />Tenant Name (If this is for a commercial business) <br />Mvcn �l�,M <br />Contractor <br />17S/S Wr�A <br />Mail Atldress <br />WA Stale Contrector License Number (required) <br />Work to be done: <br />� Side Sewer Repair <br />❑ Side Sewer Alteration <br />S� <br />❑ Side Sewer — New Installation <br />Ci!� <br />J� Install Backwater Valve (outside the building) <br />O Cap off Sewer <br />❑ Install Water Meter <br />�� � <br />Signalure <br />REVISEO f I/19R01� <br />i�-�.�-� <br />r�. <br />ai�l�u y�S 76v$16v I <br />Slate2ip <br />PAona <br />�53�35 <br />City of Everelt Business License Number (required) <br />FEE <br />30�� <br />PERMIT# <br />U1� I I <br />