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UTUTY PERMT APPLICATION <br />CITY OF fFVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — wvAv.everettwa.org <br />iI U�i ( <br />PROJECT ADDRESS <br />Property owner Mall Address City Stale/Zip Phcnc <br />Tenant Name (If this is for a commercial business) <br />1 1 <br />coty', 14Arhit110 `IS—ZO > <br />Contractor Mad Adaress Cry State!Zip Phone <br />C;AM29? 191-7 MS <br />WA State Contractor License Number (required) <br />Work to be done: <br />El Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />�nslall Backwater Valve (outside the budding) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />0 H 7-70', <br />City of Everett Business License Number (required) <br />✓j��j,,k s - S��zoi5 <br />Signature <br />FEE <br />PERMIT- <br />U 1505-0L�) <br />REWSEO 11,164014 <br />