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UTILITY PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />PROJECT ADDRESS <br />Mail Address <br />City <br />Stale/Zip <br />(yIs) <br />31L 36iY <br />Phone <br />Tenant Name (If this is for a commercial business) <br />' Mt;i l (N25) <br />A IS 15 1 D WG, L%e11�� �4EV1EeE i wa �t��3 -L4LL -gasg _ <br />Contractor Mad Address City StalerZip Phone <br />WA State Contractor license Number (required) <br />Work to be done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />0" Install Backwater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />h!53 5- (8 <br />City of Everett Business License Number (required) <br />&W-WIA <br />FEE <br />30 0 , <br />PERMIT# <br />U fO15�3 <br />REVISED 11119Q01< <br />