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UTILITY PERMIT APP�ICATION <br />Cll'Y AF FVERETT PERMIT �ERVICES <br />3200 CEDAR STR[EI', EVERETT, WA 98201 <br />425-257-881G - FAX425-25�-8857—ww�v.everettwa.org <br />�sa� �/�'WT � I <br />PROJECT ADDRESS <br />£vP /�2.%T dLoL UZS � `! <br />�ir/ /��� ��T �%'-c � ----7�-7L <br />Property Owne� hlail Address' Cdy StalelLp Phone <br />,.s <br />Tenant Name (If this is (or a commercial business) <br />e�� <br />CoNraclor tdail <br />(jOX <br />C�-.�� �����s <br />W� State Coniractor License Number (required) <br />Work to be done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sev�rer — New Inslallation <br />Y� fver�el% i,���� <br />Cdy <br />0 Install Backwaier Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />REVIiED f I/19RO1J <br />�/LS� 25"�i v�'P <br />Phonc � <br />� y�"?a3 <br />City cf Everetl Business License Number (required) <br />FEE <br />PERMIT# <br />U [� �(' � � <br />