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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 />���5 �1`, �a�ioyi4G� /Y �/� <br />PROJECT ADDRFSR <br />Property Owner <br />Mad Aadress <br />Tenant Name Q( ihis is for a commercial business) <br />� <br />IdaA Address <br />WA Stale Contractor License Number (reqwred) <br />Work to be done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer - New Inslallation <br />Cily <br />��stall Backwater Valve (outside the buil�ing) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />RE�-,s��,,,,��,,, <br />C�ty <br />Stale2�p <br />State2�p <br />Phone <br />Phone <br />V � ) I �-J <br />Ci;y of Everett Business License Number (required) <br />=a6->� <br />FE[ <br />�� � i <br />PERh11Tk <br />U l 50�'— I( D <br />