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UTILITY 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 />me <br />PkOJECT ADDRESS <br />Property Owner <br />Mail Address <br />Tenant Name (If this is for a commercial business) <br />State/Zip <br />(5�'() <br />o'r - ►881 <br />Phone <br />(425) <br />Laelr�c1a C'VOFP-E I wa gter9123 zyLi,-��cs� <br />Contractor Wit Address City State2ip Phone <br />A M liz,-I �p5 S3G l K f- <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 />6 Install Backwater Valve outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />ni,53 54l3 <br />City of Ei arett Business License Number (required) <br />FEE <br />-30 (na <br />(5 PERMIT# <br />U 1C 0& Dz0 <br />F VISEe 119Y 14 <br />