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UTILITY PERMIT APPLIC�ITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257=881 D- FAX 425-257-8857 — ��,nvw.everettwa.org <br />�3i� �� <br />PROJECT ADDRESS <br />ilc.�k �I—�-r <br />Property Owner <br />Maii Addrass <br />Tenant Name (If ihis is for a cammerciat business) <br />Contrector <br />nr�,ry,h,��, �� 5, S H,s� S <br />Address <br />rv+oen PF>:- g� 3 5 c� <br />WA State Coniraclor License Number (required) � <br />Work to be done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />City <br />�4 Install Eiackwater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Metci <br />REVISED flp9R014 <br />City <br />�f�3vY �321 <br />State2iD Phonc <br />w�a � <br />Stale2ip <br />'.� S 7rdc� fr 3Gu <br />Phone <br />053635 <br />City of Everelt 8usiness license Number (required) <br />FEE <br />� 3pa D_o <br />PERMIf# <br />� 15D�b�003 <br />