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UTILITY PERMIT APPLICATION <br /> CITY OF EVERETT PEFtMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org <br /> �513 I���-� q-� �,�� <br /> PROJECT ADDRESS ��(� <br /> �ise.c� �o� �-,c-� ��— ,,a4 qg�1 a"�-I <br /> Propeity Ovrncr I•taii Address Qry Slatc2ip Phone <br /> Tenanl Name (If lhis is for a commercial business) � <br /> 2 <br /> �- �-� �-+'�s-1 s�� �d4c�� �A �o�� � <br /> Conitador ��ail Address CAy alelZip Phone <br /> .� SS 8 ���� �� � � <br /> WA State Conlractor Licen_ umber(required) City oi[veretl Business License Number(required) <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer— New Installation <br /> � Install Backwater Valve (outside the buiiding) <br /> ❑ Cap off Sewer <br /> ❑ Instali Water Meler <br /> FEE � <br /> �� _i <br /> � 1 � � ��� PERMiTtt <br /> � a �e Oate l� � � � <br /> � 1 �10Z D <br /> F[�'�SED 1!n9^OtI <br />