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UTILITY PERM!IT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98Z01 <br /> 425-257-8810 - FAX 425-257-8857–vuww.everettwa.org <br /> 3o r ( U ���J-v� ,�1��c_. <br /> PROJECTADDRESS <br /> P��-,, ► K2s 7c� 3nS <br /> Praperty0wner MailAddross �y <br /> Y Statc2ip Phone <br /> Tenant Name pf this is for a commerdal business) <br /> f�1oe� 1'lu�,h��� r�sis y ��� sr sr= ��G,� � �� wl� ��z�� y.�s�G�s��o <br /> Contrector MallAdtlress City State2ip Phone <br /> r�+�r� P��=- g� 3 5 o D S 3 6 3 S <br /> WA Slate Coniraclor License Number(required) City of Everetl Business License Number(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 off Sewer <br /> ❑ Install Water Meter <br /> PEE <br /> , � 30,0° <br /> I ���—� {��� 1 � �'S � PERMff# / — <br /> Signature o�le U I�lU V� �O� <br /> REVISED11I19ROf4 <br />