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�� <br />UTILITY PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICE� <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />Q25-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />.Z �j�j V i rp n '!.� <br />PROJECT ADDRESS <br />����_.�.5 — <br />Froperty Ov+nef 61ad ACdress Gly Slate2ip Phone <br />Tenant Name Q( this is for a commercial business) <br />CoNraclor <br />Address <br />_� <br />� �,., � �� ��� % i <br />'NA State Conlractor I_icense Numb=_r (reqwred) <br />Work to be done: <br />❑ Side Sewer Repair <br />❑ Side Sewar Alteration <br />❑ Side Sewer — New Installation <br />City <br />[� Install Backwater Valve (outside llie building) <br />❑ Cap off Sewer <br />❑ Install � <br />i <br />/ � <br />� <br />ua�e <br />REVi5E0 11/l0%�01: <br />P <br />Sta!e2�p Phone <br />UCi C/if <br />City of EvereU Business License Numher (required) <br />FEE <br />PeRr�rra <br />� i5o3- on3 <br />A <br />