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U�'ILITY PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVEREI ,T, WA 98201 <br />425 �57-8810 - FAX 425-257-8857 — www.everettwa.org <br />', <br />/ r%O � v�-�� S % <br />PROJECT ADDRESS <br />� <br />�2 �� f �7v � 2 Z s i �,; 3 �/ �3 - �� � <br />Property Ownef Mail Atldress City State/Zip Phone <br />Tenant Name (If this is for a commercial business) <br />,�-�-�1�_,M b,.�o U�_ ,E'�r� ��sd-���w� � b� r�- ��� �'9'6�z� <br />Contrac�or <br />Addiess <br />�- � �� � � �/ �'P <br />VVA Stale Contractor License Numbcr (required) <br />Work to be done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />City <br />stall Backwater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Instali Water Meter <br />/�lVC,(: �� �V]'+/lON <br />S;ate/7_ip <br />Phone <br />���� s s� <br />City of Everelt Business License Num6er (required) <br />- �d -is <br />FFF <br />30`�' <br />PeRrtrr�i -- <br />U150�-o�f-5 <br />