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• � UTILI T APPLICATION <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 /> ( � ZCv 1N��� 1-�- <br /> i� <br /> PROJECT ADDRESS <br />� � <br /> _____�.�--��.-� � � <br /> roperty Owner PAail ACtlress C�ty StatelZ�p Phone <br /> Tenant Name (Ii th�s is for a commercial business) � <br /> .b. �� <br /> � �� � �� � ,2 <br /> Conir/�� A1a�l Addi�s City Slate/Dp Phone ! '� <br /> G In7.�--� b� - �Og <br /> S at Contractor�icense Number(required) City of Ever tt Busmess License Number(required) <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer — New Installation <br /> �l Inslail Backwater Valve (outside the building) <br /> / ` <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter <br /> FEE <br /> ��j0.6i <br /> � — � � PERMif# <br /> � iat re Date I 1 ���� ��� <br /> U <br /> I�EV:SEO tv�9.?Ofa <br />