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UTILITY PEf�IVlll" APPLICATION <br />CITY OF EVER.ETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />,��i51G �EoNA��� � vE _,_ <br />PROJECT.faDDRESS <br />i-„���r� sT cl,asz ��i� l.�oa,v�,� D�zz� F�t�T wA �Eaoi �ras �s <br />PrcpeCyOwner NaJAddress Gry State2�p Phone <br />Tenant Name Qf Ihis i, for a comme�cial business) <br />G wr�z, <br />Contrac�or ldali Address <br />WA State CoNractor License tlumber (required) <br />'r: -� !^ be done: <br />EI Side Sewer Repair <br />❑ Side Sewer Alterati,in <br />O Side Sewer — Ne�v Installation <br />C�ry <br />❑ Install Backwater �Jalve (outside the building) <br />❑ Ca� off Sewer <br />❑ Install Water Meter <br />G�� �/� <br />Signature <br />ltEv�SED tv�9^J�a <br />a./3�1 � <br />Slate/Lp <br />Phone <br />Gty of Everelt Business l.icense Nwnber (required) <br />FEE --� <br />�vno <br />PERMIT# <br />U !`�(�-IS`� <br />