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UTILITY PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA g8201 <br />425-257-8810 - FAX 4?5-257-8857 - www,everettwa.org <br />� �ll Y ��', cs � srt <br />PROJECT ADDRESS <br />cipv✓ , k <br />Praperty Owner <br />ko� <br />htail Adaress <br />Tenanl Name Q( this is for a commercial bus�ness) <br />(-f� )�c � -('r�. ( ?• 9�� <br />Contractor Ma:l Address <br />���-1�CS�16 f� <br />WA Stale Confraclor License Number peqwred) <br />Work to be done: <br />� ide Sewer Repair <br />O Side Sewer Aiteration <br />❑ Side Sewer - New Installation <br />C1y <br />O Install Backwater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Instali Water Meter <br />� <br />REV:SED IIq9�70v <br />� <br />�G ►� 6� a��r , �i�� / �?3��� <br />Gty Statc/l�P Phonc I <br />Statc/Lo <br />PhonC <br />��_c���c7 � � <br />Gty of Everetl 6usiness License Number (required) <br />F[E -- <br />��.00 <br />`a� � �PERMIT# <br />I U 1�j0�/. ��3 <br />