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UTILIT�( PERM6T APPLICATION <br />` C11"lf� OF EVERETT PERMIT SE`RVICES <br />' 3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257=8810 - FAX 425-257-8857 — www.everettwa.org <br />�,� � (�r�. �� <br />PROJECT ADDRESS <br />�� ��,e.- i� P.�,� �- ��� 2� U C�„�� r��'�� l�C'�. r �� `U ��� �� � <br />Property Owne!' Mail Address City StatelZip Phone <br />' �C< <br />r(� s ? a!`� <br />Tenant Name (If this is for a commercial business) <br />., <br />�^ , � �y�. <br />� � � �'�:, �;: l,- � �. � � i'l �� �. � L` te:- ! .,�•:- G { �r�.,,� �� '�l �� <�-,' � `! � �f �." � C� � � <br />r � ��` � � <br />ContraCto� Mail Address City StatelZip Phone <br />P� i��.��:� ������ �, ke �.- <br />WA State Contractor License Number (required) <br />Work to be done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />�lnstali Backwater Value (outside the buildingj <br />❑ Cap off Sewer <br />❑ Install Wafier Meter <br />� �• <br />� <br />REVfSED 11/19/2014 <br />? <br />-�` , : � <br />C ``°�. � `"� ,`� C.�� <br />City of Everett Business License Number (required) <br />FEE <br />c�v <br />�����. <br />� <br />•� l �C' PERMIT# <br />U � � � �-�" �� i <br />