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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 —www.evereltwa.org <br /> / <br /> ,�ll� ;,�� ��- . <br /> PROJECT ADDRESS �Z� 3�� <br /> .- U'v� �� <br /> L�� �► �� �»� s-� �e_.r--�-� <br /> Property Own�r t�lail�dtlress C�ty State/Z�p Phone <br /> �J � <br /> an�Na'me(If this is for a cummerc�business) �1 <br /> li 0 '�LU� 7 z�' . <br /> � ����� �' l 3 � V�.��1`I��,Z��?Z�� P�3�c� <br /> CoNractor �da�l Address Ciry <br /> , � 7��}- b � �-- c� <br /> N'A State Contractor License Number(required) City of Everett Business License Number(required) <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> i � Side Sewer Alteration <br /> ❑ Side Sewer — New Installation <br /> stail ck ter ve tsi he buil ic�q)/ <br /> ❑ Cap off Se�ver <br /> � Install Water Meter <br /> FEE <br /> � :X/�C% <br /> P� ��,� �/ � PERMIT# <br /> Sign Date U �'J Uy - O�� <br /> Rc`/ISEO 1 V19RJN <br />