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UTILITY PERMIT A�'PLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257=8810 - FAX 425-257-8857 —www.everetlwa.org <br /> � � � ���� �. <br /> PROJECT ADDRESS <br /> ��Sw�,�rn�e2 �SI� P��S�. f�eP� �. <br /> PropeAy Owner Mail Address City StalelZ�p Phone <br /> Tenant Name(If this is for a commercial business) �Q�jr � <br /> �I6S� <br /> ��5o��,�C ��r,r 2�6��`s sw f� s (.v� ��'�� U��� <br /> Contfaclot Mail Atldress Cily StatelZip Phone <br /> ��S�ISs ��-.�s� �s" � ��o <br /> WA State Coniractor License Number(required) City of Everett Business License Number(required) <br /> Work to be done: <br /> ❑ Side Sewer Repair ' <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer — New Instal{ation <br /> � Install Backwater Valve (outside the building) . <br /> O Cap off Sewer <br /> ❑ Install Water Meter FEe <br /> �D °6 <br /> lyC'X!/��/ I1/ " �� �� I I PERMIT# <br /> iqnature � oale � I�.'� _ 'ilGi� <br /> �`ri <br /> REVISEO IIn9/10f1 / .- <br />