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� ----- -- - - <br /> 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 /> I <br /> �101 P��-�I�e� I�v� ��s_ <br /> PROJECT ADDRESS �7 �� <br /> �il v�.Pt �e� �^*� �P�.l� � ��'I �3 � <br /> Property OwneP h1a�l Address Cily Slale/Zlp P�onc <br /> Tena� ame Qf ihis is for a commercial business) <br /> n1 ���3 �,��{�l �'Q 0 ��� <br /> 1�,�mP-�+� S�Sw CA'wro�5 1.�.� �� �� �l(�� <br /> ConlraCtOf MailAddress Cdy SlalelZip Phone <br /> ��f ss � 5 ��I ��a <br /> WA Slale Contractor License Nun be (required) Ciry ot Everett Business License Number(required) <br /> Work to be done: <br /> � Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer— New Installation <br /> � Instali Backwater Valve (oulside the building) <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter <br /> FEE � <br /> �j � ���I S 3� � <br /> ✓ PERMITri <br /> Sig lurc Datc - <br /> u �� o3 �o � B <br /> Fev;sr'n nnsaor+ <br />