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UTILITY PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - �AX 425-257-8857 — www.everetiwa.org <br />—('�`� ,�t�.�u� <br />PROJECT ADDRESS <br />Own¢f <br />Mail �dUress <br />Tenant Name Qf Ihis is lor a commercial business) <br />Conlrador �vta�i <br />____�-���-�'� //P%� <br />WA Stale Contra tor licensc Number (required) <br />Work to bc done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />Cdy <br />nslall f3ackwater Valve (outside the building) <br />❑ Cap oif Sewer <br />O Install Water Meter <br />-- -� 5i�=-- <br />��,�.,«�,,,,�.�.., <br />Ciiy <br />L% �7�Q <br />;7/'-� 1.�9— <br />StatelZip Phone <br />StatNZip Phone <br />-t»`�S�T <br />City of Everelt Business License Number (required) <br />FEE <br />� �D��o <br />�J( / l S _ PLRMITI! _� � <br />o��� ���o�—�� l <br />� _ <br />