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UTILITY PEF�MIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDP.R STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —vwvw.everettwa.org <br /> .�� r���a� �- <br /> PROJECT ADDRESS <br /> ��(i G � '�Ine�/ �v�✓"��'_ <br /> Property Owner P.tail Address City S�ate/Zip Phone <br /> Tenant Name (If this is for a commercial business) <br /> �'„r <br /> c'v�f0 -�r,� lo6SS r..�k..,•oa�vc� T�,tw'!!r� u.lt— �Ei�P S�Zs 7�4�2zs <br /> Con�factor Mail Address City StatelZip Phone <br /> Qv{�o �,�SL /22 B,e, 0_,�� Z l� <br /> WA State Contracror License Number(required) City o(Everett Business License Number(required) <br /> Work to be done: <br /> � • <br /> p Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer— New Installation <br /> ❑ Install Backwater Valve (outside the building) � <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter <br /> FEE <br /> 3��C.7 <br /> � ��, PERMIT# <br /> ,` Signature Date � ( r O� _ I G <br /> T .� � <br /> REYISEO 11/19?O1� <br />