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UTILITY PERMIT APPLICATION <br />CITE( OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />350'3 Roc.4-J11ti- Au o— <br />PROJECT ADDRESS <br />Property <br />Mail Address <br />Tenant Name (If [his is for a commercial business) <br />Contractor Mail Address <br />WA State Contractor License Number (required) <br />Work to be done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />City <br />fInstall Backwater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />City <br />Slate/Zip <br />State/Zip <br />Z12- <br />Phone <br />Phone <br />D 'i; Z`1 V <br />City of Everett Business License Number (required) <br />FEE <br />J 3000 <br />PERMIT# <br />Dale U [503 _ 0 <br />8/0 <br />fiFVIScD 11/19geiC <br />