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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 />3o&M <br />PROJECT ADDRESS <br />Property Cwner <br />(Jail Address <br />;R0io Lc' <br />Tenant Name (If this is for a commercial bus.,iess) <br />city <br />(QZ6) <br />3q5 -Z�io <br />state/Zip Phone <br />C4<7% <br />—SccSG <br />51ate21p Phone <br />Contractor &jail Address City <br />AME ��1 tQ !&l K � <br />WA Stale Contractor License Number (required) <br />Work to be done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />®" Install Backwater Valve outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />`> C3 <br />City of Everett Business License Number (required) <br />J <br />PERMrf# <br />7o <br />REVISED I YAR1201C <br />