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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 />(�ol� �[¢�; <br />PROJECT ADDRESS <br />Property Owner <br />O1 <br />Ivlail Address <br />Tenant Name (It lhis is (or a commercial business) <br />. <br />Conlractor MailAddress <br />�h <br />F�os�znlL�C�'3�$ i <br />WA Stale Contractor License Number (reqwred) <br />Work to be done: <br />� Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />City <br />❑ Install Backwater Valve (outside the building) <br />O Cap off Sewer <br />O Install Water Meter <br />REVISEO 1V19R��4 <br />�v. <br />Cily <br />S- <br />SlatelZip <br />Stale/Zip <br />Phone <br />Fhone <br />;" 3y� L( <br />City of Evere�t Business License Number (requued) <br />FEE <br />30 °o <br />PERMIT# <br />U � 5�(p � D��l <br />