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I <br />_ F�_,=��,.,.,:�„— <br />I <br />� UTILITY PERMIT APPLICATION <br />j CITY OF EVERETT PERMIT SERVICES <br />� 3200 CEDAR STREET, EVERETT, WA 98201 <br />� 425-257-8810 FAX 425-257-8857 — ww�v everethva org <br />� �� ��c���) �e� A U�. <br />I PROJECT ADDRESS � <br />���i C� <«d ��� ��� _ <br />Property Oweer Ltan ACeress C,ty <br />icna�� �e If th�s is for a coirmeraal b�s�ness) <br />� <br />� !b�l��le. ��� �� <br />, a�� � ��J� ���3��' S� Sw• �ly�5 <br />Contractcr M11ad Address Gty <br />w� ���ol <br />State�Z�p <br />E <br />pna-�• <br />Phcce <br />� ���� 5 D.� � 8a� <br />� `eV,1 State Contrador License Numb�rr.r,uired) Cdy of Fverett Busmess License Number (requved) <br />Work to be done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />��. Install Backwater Valve (outside the budding) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />FEE �I I <br />r --- ---- <br />I <br />�D � I <br />� <br />PERh1IT" I I <br />U I_sd3 -o3z JJ <br />