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UTILITY PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, [VERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org <br /> W <br /> %52�� �u��G.v / 'VC� ��� <br /> PROJECT ADDRESS <br /> �iw,c� I �"r-�c�c� � �a�rx-C' <br /> PropOAy Owncr Mail A'.dress City Sta�clZip Phone <br /> TenaN Name(If this is for a commercial business) <br /> ('awtol�' �lls � � um��na �0 55�1 � E�r�.� �� RB�O <br /> Con�raCtOr Mail Adtlress Gly Slate2ip Phone <br /> �;A 1�`� �B� 1`J_J.� N1 S d �-1 '7 7 a 3 <br /> WA State Contraclor License Number(requued) City of Everett Business License Numher(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 /> ❑ Cap oN Sewer <br /> ❑ Install Water Meter FEE <br /> 3��� <br /> . / �j �S PERMIT# <br /> Signalure % Date I ' I � O I I ` D � � <br /> u '-(� � <br /> o��„«�.,,.a,.,,, — <br />