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UTILITI( PERMIT 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 />�,�� An �c�lJvuq�L�I <br />PRC�JECT ADDRESS <br />., � . ., . � i , � � <br />Property Owner <br />=-�- <br />Mail Address <br />Tenant Name (If this is for a commercial business) <br />Contractor Meil Address <br />� j'��1� � �� ��o � i'� �- <br />WA Stale Contractor Licensa Number (required) <br />Work to be done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer - New Installation <br />�� <br />c�ty <br />L7 Instal! Backwater Valve outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />Z- <br />ntvisen >>ns.aoia <br />Ciry <br />Stale2ip <br />�4 <br />SlalalZip <br />?�Z -DGz� <br />Phono <br />� �� 5 <br />Phone <br />C7 `7 � °J � <br />City of Everett Business License Number (requued) <br />3v °° <br />PERMIT# <br />U ISOZ-fl(nZ <br />