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UTILITY PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />I o n, `� � 47.�5-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />C�2�- �� � �, `� �� <br />D , ��c`��� <br />PROJECT ADDRESS �I, <br />�.7N <br />� ;�c�c�f �Ulc� �-�t U� I'�" � �� �a�� � �y �1,�se� Wl4 _ <br />Property OvJ�er ' <br />Tenan� e Qf ihis is for a <br />� ��O�Gt,`�,,�/�-8P�"� � <br />1 <br />Mail Adtlress <br />�.ommercial business) <br />���3 a����s�s�� <br />CoNraClof � Mail Address � Cily <br />i���SS �r � � � <br />WA State Conlracior License� mber (required) <br />Work to be donc: <br />❑ Side Sewer Repair <br />❑ Side Sewer AI!eration <br />❑ Side Sewer - New Installation <br />� Install Backwater Valve (outside the building) <br />❑ Cap of( Sewer <br />❑ Install Water Meter <br />Gty <br />StateO_ip <br />�j�5- <br />g Dllq_ <br />Phone <br />a��- <br />���s- <br />�� <br />Phone <br />Ci� re�ess License Number (required) <br />_� �c���.��,-/ -- � l L �o�S' <br />Si ature ����P <br />�u ��is� u i vien,o�a <br />Fr:� <br />��, °� <br />IPFRMITI! <br />LI J �� ��� <br />u <br />