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UTILITY PERMIT AP�LI�ATION <br />CITY OF EVERETT PERM�T SERVICES <br />3200 CEDAR STRGET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 —www.everettwa.org <br />�? a ° ���- - <br />PROJECT ADDRE S <br />Owner <br />' V / <br />� <br />s �� � <br />Idail Adtlress <br />Tenant N m�(I( this is for a commercial business) <br />ab.�o��� �`�'�� <br />�w1 �.� ��a� a��<< <br />�� <br />Cnnirador tdad Address City <br />' ����5���-��� <br />WA State Conlractor Lice e Number (required) <br />� <br />� Work to be done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />(�1 Install BackwatPr Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />� <br />NEVISF.D 11/iSROP� <br />Ciry <br />q��i <br />�--� ��� <br />v� <br />I,��- l�go� <br />Phone <br />Phone <br />�lg�� <br />Ciry of Everett Business License Number (required) <br />�-�015� <br />FEE <br />� 3D.00� <br />PERMIT# <br />U 15��i- l3� <br />