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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 />�� 7 29 �:� n; � Av.� �.,ar-� <br />� <br />� PROJECT ADDRESS <br />� � i' e.✓ � � Vk-� <br />OwnBr Ma�l Address <br />Tenant Na ne (If this is for a commerdal busmess) <br />l -u�^�t�.�L.0 �urv� �� `�0.5 <br />Contrador '�tad Address ���v <br />C�M�B���n t�1S <br />WA Stale Contrador License �umber (required) <br />Work to be done: <br />� Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side wer — New Installation <br />Install Backwater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />.. <br />. <br />o�,,,«�.,,,o��., <br />C�ly <br />I <br />. <br />Slale/Zip � Phone <br />S:ate?ip P�one <br />Oy�7D� - <br />City o( [verett Business License Number (required) <br />FEE <br />'� 30,°° . <br />PERMIT# <br />� 15D�i— 0�1�. <br />