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____� __ _ <br />� <br />i <br />UTILITY PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 i;EDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8957 - www.everettv+a.org <br />� y GJ �e �C1� S a- F'�,; c�- <br />PROJECTADDRESS <br />er'.�lc -�l'e�wel� ��_��6 n�u,�,��_ �'�- `�,��`' <br />Propetly Owner 61a�1 Adaress Ciry State2�p Phone <br />Tenanl Name pf �hls is for a commercial business) <br />l.S � /�'.( .�f- Se�.., <br />Mail Address <br />�i^;'Co�L �; d s ,� <br />WA Slate Contractor License h�mber (reqwred) <br />Work to be done: <br />�Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer - New Installation <br />CAy <br />O Install Backwater Valve (outside lhe building) <br />O Cap of( Sewer <br />❑ Install W�ter Meter <br />S-s <br />F,� � ,,,,,,:�,., <br />L� �I �(� � �o�-'SkT <br />SIa1e2�o Phone <br />-� .���1/ <br />Cily of Eve�elt Husiness Licensc Number (required) <br />FFE <br />�� <br />PFRMIT# <br />ui5o5 - o2s <br />