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UTILITY PERMIT APPLICATlON <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />� 30 � G ve��..rP e.., 1/�/� <br />PROJECT ADDRESS <br />Property Owner <br />�a� 2,v- � <br />Tenant Name (If �his is tor a com� <br />��w <br />Mail Address <br />��A <br />Fcial business) <br />��s � <br />Conlraclor Mail Address <br />��SG���v���Q% <br />WA State CoNractor License Number (required) <br />Work to be done: <br />�Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />Cily <br />❑ Install Backwater Valve (outside the building) <br />❑ Ca� off Sewer <br />❑ Install Water Meter <br />REVISED II/19QOfa <br />Ciry <br />Stale/Zip <br />'��� h� wr� ��6 <br />State/Zip <br />Phone <br />Phone <br />� 3?�5� f- <br />City of Everett Business License Number (required) <br />' Fz��sf <br />FEE <br />3v o� <br />PERMIT# <br />U (cjD(' IfoC7 <br />