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UTILITY 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 />c� l ��-� I" � �� l`t " � <br />PROJECT ADDRESS <br />Owner <br />�� v'�"' 1 �(.lrJle� Q�(� <br />` 1,1adAddre:�., <br />Tenant Name (II this is for a commercial busine�ti) �� <br />_ . �'��� �3� y�.s�. <br />CO�i�0Ct0f hlailAddre55 Cily <br />����5�-�. ��- <br />WA State onlractor Lic Number (required) <br />Work to be done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />� Install Backwater Valve (outside ihe building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />neviseo nn,.zra <br />City <br />� Kg,O� N.i <br />State2ip <br />State/Zip <br />Pf�one <br />Phone <br />0 5c gav <br />City of Everett Business License Num6er (required) <br />-� ��� ��I � <br />FEE <br />3V � <br />PERMCT'# <br />U ���1^ l�� <br />