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UTILITY PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX425-257-8857—wiAw.everettwa.org <br />3 52n . - <br />P(ROJECj ADDIR SS <br />35%� Od l <br />Property Cw er Mail Andress <br />Tenant Name (if this is for a commercial business) <br />qj`7 a('.0C1 1-41Gt rc'l d K, cE- v ry r <br />Contractor Mail Address City <br />'A M'- �b �; ( Kt- <br />VVA State Contractor License Number (required) <br />Work to be done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />9/install Backwater Valve outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />�g25�u(�-3�f7Z <br />City State2ip Pr»no <br />(42-5) <br />t�3�03 2-4�L--gcts <br />State2ip Phone <br />City of Everett Business License Number (required) <br />0 <br />30 C <br />PERMIT# <br />U 1503-01 <br />REVISED ri/1 M14 <br />