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UTILITY PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREEf, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />5`f l7, D lC���=�-; <br />PROJECT AODRESS <br />Property Owner <br />P�ail,�dJr_ :s <br />Tenant Name (If this is for a commercial business' <br />Ciry <br />c <<z,5� <br />;�c� , �9.3 - 32 � <br />SWte/Lip Phono <br />(4 LS) <br />" Z�-1`t -- �1�17 -ri <br />�- �� �,Gc�C, i_c��l,�� da C��;�-�-I i ��� a �it32o� <br />Conitactor AfiallAdOress City SWIo/ZiP Phone <br />�� M�.��� 55 �� � K � <br />WA Stale CoMractor �icense Number (required) <br />Work to be do�e: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />Ef Install Backwater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ install Water Meter <br />aaviseo nnsoore <br />c�� 3 `� �(f3 <br />City of Everett Business License Number (required) <br />�� -- �7-20�� <br />�Opa <br />PERMIT# <br />� ( �d `�- 0�7 <br />