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UTILITY PERMIT APPLICATION <br />CITY OF EVERETl' PERMIT SERVICES <br />3200 CcDAR STREET, EVERETT, WA 98201 <br />4?.5-257-8P70 - FAX 425-257-8857 —www.everettwa.org <br />�A <br />� 3 i � �2�; � ,��-e- ��-f <br />PROJECT ADDRESS <br />Property O�vner <br />Mail Address <br />Tenant Name (I( Ihis is for a commercial business) <br />M„e„ P(�,,,��,., ��s� s �iL,- <br />Conifacl0f Mail Address <br />M� I'�P� Sfl3 �r� <br />WA State Contrac�or License Number (required) <br />Work to be done: <br />U Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />Ci�y <br />'� Install Backwater Vaive (outside the building) <br />❑ Cap off Sewer <br />❑ Instali Water Meter <br />REVISED 11H9-?O�i <br />C dy <br />� <br />Slate/Zip <br />tizs <br />Phone <br />Phone <br />� <br />vS 3G�S <br />City of Eve rett Bus��ess License Mumber (required) <br />FEE <br />3�ov <br />PERh11T� <br />U (5b3-03 � <br />