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IITILITY 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 />I7Z2 �¢ihro.,r- �v� �1 ��r��-i7'— <br />� <br />PF:OJECT ADDRESS <br />Property Owner <br />Mail Atldress <br />Tenant Name (II this is �or a commercial business) <br />City <br />�r�l�1-i���S ` �urh�(r1Gi `P0.55�1 <br />ConttaGc� Mail Adtlress City <br />Cf�Mr'R���1 �� t�1S <br />1NA State Coniractor license Number (reqwred) <br />Work to be done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer— New Instaliation <br />Install Backwater Valve (outside the building) <br />� Cap off Sewer <br />❑ Install Water Meter <br />onncrn �v�arxn� <br />State/Zip <br />State2ip <br />. <br />rnone <br />Phone <br />vy��o3 <br />City of Everett Business License Number (required) <br />FEE <br />�R'��,D� <br />PERMIT# <br />U 15��i �6loZ <br />