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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 />JRkl \1)0, Al�r <br />PROJECT ADDRESS <br />Property Owner lillail Address City State/Zip <br />Tcoant Name (If this is for a commercial business) <br />(360) <br />/v - P83 <br />Phone <br />(y25) <br />H SS 2�n� l� rz l�� dR UL 7iT > �18�� 2qq--945-9 <br />Contractor Mad Address City State0p Phone <br />A KUaYj gk l 0, -- <br />WA Stale Contractor License Number (required) <br />Work to be done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />t3" Install Backwater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water N' <br />(2) ':� �3 514 <br />City of Everett Business License Number (required) <br />30 U0 <br />PERMIT# <br />UlgI(-oq8 <br />REVISED 1111 "01 <br />