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<br /> ' : UTILITY P�RMIT APPLICATION '
<br /> � CITY OF �VERETT PERMIT SERVICES '
<br /> � 3200 C�DAR STREET, EVERETT, .WA 98201
<br /> I 425-257-8810� - FAX 425-257-8857 -www.everettwa.org
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<br /> PROJECT ADDRESS _ i . ' ' •
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<br /> iProperty wner! ���1aIL'Address j � � Cily� � SlatelZip Phone
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<br /> Tenant Name (Il this is(or a comniercial,�usines�) , . �
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<br /> ConUaclor . �a1ail�.Atldress ��, : �� . C�I, � � . ' Stale/Dp. Phone
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<br /> 7VA State Centrartor License-Number(required){ ` ' � � �• City of Everetl Bu.,iness License.Num�er(required).
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<br /> � Work to be done; � , � : :�� �''
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<br /> ❑ Side�Sewer Repair • 1 ' � �
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<br /> ❑ Side Sewer Alteration : .. ; + . '' , � I
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<br /> I ❑ .Side Sewer— Ne�v.lnsiallation� : '
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<br /> ' fA�lnstall Backwater V�Ive (outside the'6uildimg) � � � •; , �
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<br /> � ❑ Cap off Sewer . � ' " � .
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<br /> ❑ Insiall Water;Meter .� . : : ,
<br /> 'FEE .
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<br /> � Signa�ure: � . . /� . t . . ..Datc .. . � ^ .l .:f V I
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