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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 />3-� �> v���t � s <br />PROJECT ADDRESS <br />�U /'�1 � /�' i��O�CE' <br />Property Owner t,^ad Adtlress ���Y <br />Tenanl Name (If this is (or a commercial business) <br />Cqr.r/'Fr��Y��u�1` �O <br />CoNractor Mail Address <br />G,�'rl P� P1yl7��S <br />1NA S!ate Contractor License Number (reqwred) <br />Work to be done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer - New Installation <br />SS`/� <br />cny <br />Gcl�� fnstall Backwater Valve (outside the buiiding) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />pELa5E0 nn9?01: <br />��2 <br />Slate/Lp <br />�V�c'c'�^` <br />Stale/Z�a <br />��n� <br />Phone <br />Phone <br />�� � /�J <br />City o( Everetl Business License Number (required) <br />FEE <br />,3 D _ ��l/�" <br />PERMIT# <br />U ( S�� �'� 3� , <br />