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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 />113C�S �.J Il�� L��SOn �� <br />PROJECT ADDRESS <br />Property Owner <br />Mad Address <br />Tenant Name (If this is for a commercial business) <br />Coniraclor Mail Address <br />s�c�l-� �s� , ZZ� R <br />WA Stale Contractor License Number (required) <br />Work to be done: <br />%1 Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />Ci1y <br />q� Iolvc� <br />City <br />❑ Install Backwater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />FEViSED t V�940�d <br />3 <br />Slale/Zip <br />� � /� .� 27 � <br />StatelZip Phone <br />Phone <br />3�7z�� <br />City of Everett Business License Number (required) <br />FtE <br />� �� <br />PERMIT# <br />�i5o�-c�(c� <br />