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UTILITY PERMIT APPLICATION <br />C1TY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettNa.org <br />� � 5 z �7 b �(,4�eS � � <br />PROJECT ADDRESS <br />Ss�. l• �� ISon _ <br />PropeAy Owner MaA AdOress Gty <br />Tenant Name Q( ihis is for a commercial business) <br />�'aw1G1J-¢..11� ���.cr���,n� `�0 55�{I <br />Conlr8Ct0�rr Ma�lAdtlress C�ty <br />,�'^Mr'��19 �7 MS <br />\VA State CoNractor License Number (requued) <br />Work to be done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — Nev� Installation <br />nstall l3ackwater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />� <br />oco,ccn . �nannre <br />Statc/Lp <br />State/Zlp <br />. <br />Phane <br />Phone <br />O'� �7a3 <br />C�Iy of Everett Business License Number (required) <br />FEE <br />�''J��°� <br />� �� I UR I 5 D� � D� I <br />