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UTILITY PERMIT APPLICA�ION <br />CITY OF EVERETT PERMiT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 9B201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwacrg <br />n <br />� � �� � �,v� �� <br />PROJcCT ADDRESS <br />ii Adtllgss <br />��� <br />Name � this s for a commercial business) <br />��'�i �.� �� <br />ContraClor Mad Adtlress Cily <br />�S7�CL.��i �I �-1�- <br />A State Contraclor L�cense Number (required) <br />Work to be done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New I�stallation <br />'�install Backwater Valve (outside the building) <br />/ <br />❑ Gap off Sewer <br />❑ Install Water Meter <br />aeviseo i v�e �: �w <br />City <br />StalelZip <br />StalelZip <br />Phone <br />Nnone <br />Gty ot�e� Busi� L�nsc Number (required) <br />FEE <br />��.�� <br />PERMIT� <br />U 15by - D��I <br />