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UTILITY PERMIT APPLICATION <br />CITY OF EVERETT' PERMIT SERVICES <br />3200 CLDAR STREE��, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everethva.org <br />� �-�'�J f���C vuqa( �/�� <br />PROJECT ADDFESS -T— <br />�I � l-U-� ►�,. � s!� _—_�S <br />� <br />' Pwperty Or+rer tAad ACdress <br />C�ty <br />Slate2ip <br />Tenant Name (I( ihis is for a commercial b�siness) <br />c �� <br />�'w,r�(,�,�� �,S k va _�. 5��t 1 (�q c1-���-� w <br />Contradory 11aiIACcress C�!y Stak;'Zip Phorc <br />GAW( P t�� l�'11 �7 �N1 S <br />1N� State Cont�actor Liwnse Number (reqw;ed) <br />Work to bc done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />G Side Sewer - New Installatron <br />Inslall I3ackwater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />..,:_., .. <br />Phone <br />p�Z�03 <br />C�ry o( Everett Business License Number (raqwred) <br />FEE O <br />�� � U� <br />PERh11T« <br />U ��U�" I O,h <br />