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UTILITY PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SE�VICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857—vv�vw.everettwa.org <br /> _��� �S�` � � ��� <br /> PROJECT���� O� � /A� �� �� ��Q� <br /> �-t ti <br /> Property Owner Mail Address � City Slale2ip - Phone <br /> ( � <br /> Tenant ame (If this is for a commercial business) � <br /> 2G <br /> �w�e.��d-��r� �a'� �36�ti5-�S���f I�,(� ��6 �l�� <br /> Co irac�of Mail Address City Stale2ip Phone <br /> �(S g� ` S o�'� �� <br /> WA State Contractor Licens mber(required) Cily of Everett Business License Number(required) <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer— New Instailation <br /> � Install Backwater Valve (outside the building) <br /> ❑ Gap off Sewer <br /> ❑ Install Water Meter <br /> FEE <br /> 3�� <br /> ����� ���u � <br /> PERMIT9 <br /> ignaWre Dte � iy la �o�� . <br /> FEVISEO f fn9Rml <br />