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UTILITY PERMIT APPLO�AT�OiV <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 />� 32 �' /i��G� ���C0���2 <br />PROJECT ADDRESS <br />�..P�'� �{/v/� �° 7— J��� -� G� U�G-� � <br />Property Ov+ner Mail Address ���Y <br />Tenant Name (If this is for a commeraal business) <br />�1'�"�ll��u �it�� $�vC/`'V� �l`a��a� <br />Con�ractor (.7ad Adtlress ���Y <br />��/�L� � �a��v�� <br />WA State Contraclor Lkense Number (requiretl) <br />Work to �a done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer - New Installation <br />Inst�,ll Backwater Valve (outside ihe building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />��,�/� ' _ <br />Signaiure <br />RE�'�SEO �1n9RJ�+ <br />StalelLp / P�one <br />-7� o -- ��z �5'G�'a <br />c�Ccp.� Cva <br />SlalelZ�p <br />_� <br />—O/ � <br />Phone <br />� S7 sSG <br />City ot Eveiett Business L�cense Number (required) <br />FEE � <br />�b <br />PERh1IT# <br />� ��o a- oo i <br />