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UTILITY PERMIT APpLICATIOtV <br />CITY OF EVERETT PERMIT SERVlCES <br />3200 CEDAR STREET, EVERETi', WA 98201 <br />425-257•8810 - FAX 425-257-8857 — www.everettwa.org <br />i � U� �t.�cJ�,� <br />PROJECT ADDRESS <br />Owner <br />maanddress <br />Cily <br />Tenant Name (If ihis is for a commercial business) <br />�'�oen (��u�,hr�� r�s�s yi��st.s� S��G��. <br />Contractor VMailAddress C;�y <br />rv+0u� P��=- FS Ss 3 S o <br />WA State Contractor license Number (required) <br />Work to be done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />O Side Sewer — New Installation <br />,�' Instail f3ackwater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />REVISED 11119401a <br />Stale2ip <br />Gl�ZS�, � <br />Stnte2ip Phone <br />Phone <br />�fr�Gu <br />OS'a6� S <br />City of Everelt Business License Number (required) <br />PERMIf# <br />� I�(�1- D� D <br />