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� <br />UTIL'ITY PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STRFET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />�Z�� �c��le� �� <br />PROJECT ADDRESS <br />PropeAy Owner <br />Mail ACtlress <br />Cily <br />Tenanl Name (If this is for a commercial businessj <br />$la /l—l/� S�ce�-.lt� �C !��`L- <br />�����ti G �U'� �' � w�i' <br />Conlraclor MailAddress City Stale/Zip <br />� 'L r'r L �- o���� <br />A Slate Contractor License Number (required) <br />Work to be done: <br />❑ Side Sewer Repair <br />O Side Sewer Alteration <br />O Side Sewer — New Installation <br />� Install Backwater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />REVISEO 11/19R011 <br />;���'� 5�9 �`�� <br />i� <br />Slate/Zip Phone <br />Phone <br />fl 5� 55� <br />City of Everett Business License Number (required) <br />FEE <br />� b� <br />PERr1IT# <br />U (�I�- GY51 <br />