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UTILITY PERMIT APPLICATION <br />CITY OF EVERETT PERMlT SERVICES <br />3200 CEDAR STREET, GVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — wvuw.everettwa.org <br />�S � � C�'� �- <br />PROJECT ADDRESS <br />Froperty Owner <br />�2� C�.,v2 � ��.,��.6-� <br />Mail Address <br />Tenanl �Vame pf this is for a commercial business) <br />"ioe�, P/U�,b��,� ��s�s U���st <br />Coniractor Ma�lAddress <br />mo�nP�'�k�35o <br />WA Slale CoNrador license Number (required) <br />Work to be done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Aiteration <br />❑ Side Sewer — New Installation <br />Cdy <br />: S�o��..� c�. <br />City <br />�Instail Backwater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Instail Water Meter <br />��— s -� �-� s– <br />�n vrf u nnvia�a <br />State2ip <br />wla ��2�a <br />StalelZip <br />r ��oso� <br />Phonc <br />? S �c� � 3Gv <br />Phone <br />05�63 S <br />Ciry of [veretl Dusiness License Numher (required) <br />FEE <br />� � OZ:� <br />PERM1TJt <br />--- � I 505 - � ZZ <br />