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UTILIiY PERMIT APPLICA.TION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - f-AX 47_5-257-8857 — www.everettv,a org <br />! 21 c� Z ►N� C � � � �— -�,� <br />I PROJECT ADDRESS � <br />��� _���;; _2i vZ_ v� - n �- �u � Ji- 2 �1 � <br />'i Proper�vner t.1a�lAtltlress �ty Slale/7ip Phone <br />1 <br />� <br />�I Tenanf Name (I( this is (or a commerc�al bus�ness) <br />Coniractor � t.lail <br />f}� Y/� �v�'��'���D <br />b\A Staie Conirador Lkense Number (reqwred) <br />Work to be done: <br />❑ Side Sewer Repair <br />O Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />Gty <br />(� <br />islall Bar,kwater Valve (outside the bwiding) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />StatMl o <br />% � (L� � <br />Pnone ; <br />City ol -�verett Eus� ense Number (required) <br />�' Z—, <br />-- � igna�wc --- -- ua�e - <br />��.,,���,.�s:�„ <br />F[E <br />C� <br />� <br />�ERrirru <br />U1�01— <br />