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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.everettwa.org <br /> ��2 ��.c,KeIZ A�� r�as <br /> PROJECTADDRESS �{g�� S7D" <br /> � iZ��-kS�� )� �ur-k� �t,�R�� �-/� .53&3 <br /> � <br /> Property wner Mail Address Cdy Statcl ip Phone <br /> ��/� <br /> Tenanl Name(If lhis is for a commercial business) �j <br /> � • �� '��3 � 6��' .sw �,�r�s c�a� �1�'o�� �jq� <br /> ��� '� .� s� �l <br /> Conlractor lda�l Address City Sta' 2iD Phone <br /> ��I����, �\� fl��l 8�� <br /> WA State CoNractor Lic ns Number(required) Cily of Everelt Business License Number(required) <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer— New Installation <br /> � Install Backwater Valve (outside the building) <br /> O Cap off Sewer <br /> O Install Water Meter <br /> r-ee <br /> �O C,i� <br /> , 2, �3'�01� � <br /> �u�, � : . <br /> PERh1iT'# <br /> ignature Date � I �"� _ f�("��� <br /> L �.�t� <br /> AEI'�SED�r/i5?Ota <br />