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. _ UTILITY PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICE� <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 – www.everettwa.org <br />l{ � V' � e� �-�i2 i <br />PROJECT ADDRESS <br />Property Owner <br />MatlAdtlress <br />Tenanl Name (If this is (or a commercial business) <br />� wL Li <br />COniraCior Mail <br />��- � d /P� <br />WA State Confractor License Numbcr (required) <br />Work to be done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />O Side Sewer – New Installation <br />VGi�4 <br />�� <br />cny <br />istall Backwater Valve (outside ihe building) <br />❑ Cap ofi Sewer <br />❑ Install Water Meter <br />� <br />-- -- Signatme <br />I:f-l":.! (J I li I'I i0/J <br />vE q=ia--f �-.,w�- 9`�-�`5 <br />�,iy Stale2ip Phonc <br />r� .�Z ��' <br />;11/`t17,�2�c— �� •���Z� y,��`� ��z � <br />Slatc/Lp Phonc <br />_LL_� �' `� <br />City of Everett Business License Number (required) <br />_�_� - <br />-- .���. — - --S — <br />FEE r—�—� — - <br />30w <br />-_-, <br />NeRr�rru <br />U150�-�(� <br />