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UTILITY PERMIT APPLICATION <br />CITY OF EVERETT PEr.MIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257•8857 —'Nww•everettwa.org <br />� � /c5 ,Q,4-� K. � �� �- <br />PROJECTADDRESS 'r <br />i <br />/ 7 l s'2�w4.� Ar� -�e--.�.� ,�— ��rz-a �' <br />Propehy Owne� Mail Address Gty Stale2ip Phone <br />l enanl Name (If ihis is tor a commercial business) � y�I , � <br />�dlol!—Vr'S�`cc<����* /' "�`` <br />C <br />CoMractor <br />�6;�sqL�� <br />WA Sta!e Conlrecicr License umber (required) <br />Work to be done• <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />G <br />City <br />nstall Backwater Valve (outside the building) <br />O Cap off Sewer <br />❑ Install Water Meter <br />RENSEO f I/IA'JOb <br />.� — <br />StatelZip Phone <br />D 57 5Sl'v <br />Cily of Everell Business License Number (required) <br />FEE �� <br />3d <br />� ,j ^ (y PERMIT# <br />—r U ! `�r2 _ �G� <br />