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a <br />UTILITY PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SER\�ICES <br />3200 CEDAR STREET, EVERETT, WA S8201 <br />425-257-8810 - FAX 425-257-8857 — www.ever2ttwa.org <br />���1 �--��f-� �- <br />PROJECT ADDRESS <br />��.� Nv�;�e 35�� ��.b�z r�.,� t���i ���.�I �s�- 37 s� <br />Property Owner Mall Address City State/Zip Phone <br />1-enant Name (If this is for a commeicial busiress) <br />COnt�actOr �da�IAddcess <br />�'�-�i�TiJ � IUC- � l <br />WA State Contractor License Number (required) <br />Work to be done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />Ciiy <br />� install Backwater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />nat <br />nEwSEo i vi �n, m a <br />�fi�tS� �G� <br />SlatelZip <br />fl <br />Phone <br />�" <br />City of Evere�t �usiness License Number (required) <br />= <br />FEE <br />i�� <br />PERMIT# <br />UlSc�3-uo� <br />