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� UTILITY PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EV[RETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />a3ol <br />�—� o—.' - ��Z= S� <br />PROJECT ADDRESS <br />a�� -ay�-� <br />� J o l —J.��- .Si -�z.� �/'Q.. ��Zt�3 <br />nroperty Ov+ner Mad FCtlress CAy State�7ip Pnone <br />Tenant Namc Qf Ihis is for a r.ommercial business) <br />�L N�1 �U ( <br />Contrac�or N�ad <br />/�' Q�j, ��� / � <br />�i� <br />W� State Gontractor License Number (reqwred) <br />Work to be done: <br />❑ Side Sc;wer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Installalion <br />�r <br />Q'y <br />stall Backwater Valve (outside the building) <br />❑ Cap off Sewer <br />� Install Water Meter <br />nH��sen nnsrtm+ <br />Stale/Zip <br />l�z� = y� �—oJZ� <br />Phone <br />o s-� r� <br />Cdy of Everett Business License Number (reqwred) <br />-��-� :�� <br />FEE <br />��00 <br />PERMITn <br />U)505-n� <br />