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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.everetlwa org <br />��I�S C�� �� Av� <br />PROJECT ADDRESS , <br />I�Xi <br />Ov+ner <br />� <br />1 ena 1 ame Qf this is (or a commercial business) <br />�z� � S-�•SW <br />Contraclor Lta.l l�dd�ess � ���y <br />I <br />�4 � ��-1� S <br />II \NA Slate Com�actor Lice se Number (required) <br />Work to be done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer - New Installation <br />� Instali Backwater Valve (outside the building) <br />❑ Cap oft Sewer <br />❑ Install Water Meter <br />. <br />aev:s�o �„ia•o„ <br />Cdy <br />State/Lp <br />� <br />Phone <br />P'+one <br />���o � � <br />City of Everett �usiness License Numbcr (reqwred) I, <br />FEE <br />� �D °� � <br />tl <br />PERMIT# <br />U d�D� -O�I <br />