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UTILITY PERMIT APPLICATION <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 />3��j <br />� �'��Y� ( a�ve ��/e'�e� <br />PROJECT ADDRESS <br />C/�c��� /zcc��S Y3��1 �e�e� I �(/C�l��%T• �f% `�FS"Zl'J� <br />Properly Owne� Mail Address City Stale/Zip Phone <br />Tenanl Name (Ii ihis is (or a commercial business) <br />�ie� i�,� <br />Coniractor Mail Address <br />0 3 7 7 �. �-1 <br />WA State Contractor License Number (required) <br />Work to be done: <br />�. Side Sewer Repair <br />❑ SideSewerAlte,ation <br />❑ Side Sewer — New Installation <br />Y�,ia<<m�lal <br />City <br />❑ Install Backwater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Ins;all Water Meter <br />� <br />rvevisr-o r insaoia <br />� tA � q�l <br />Slate/Zip <br />32`l <br />City of Everett Business License Number (required) <br />FEE <br />�?J"�n�0 <br />PERMIT# <br />u 15b�� o�l <br />0 <br />