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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 — wuvw.everettwa.org <br />f0 H 2 a�I 1�, I�.- s( ��- <br />PROJECT ADDRESS <br />Property Owner <br />Mail Address <br />Tenant Name (I( lhis is for a commercial business) <br />Cily <br />State2ip <br />Phone <br />Sfil��f� .S�wa�s I�-� Zo�� cci��o� %r.� ��.e� r5� w�9g2 <br />Conlraclar MailAddress City State2ip � Phone <br />N K��-���rz. <br />ST 2 I C S� 4� S� I� 0535i � <br />WA State Contraclor License Number (required) City oF Everetl Business Li�ense Number (required) <br />Work to be done: <br />�Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />L� insiall Backwater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />J-�—r� <br />FEV�SED If/19/Mf� <br />FEE <br />��� <br />PERM1TIt <br />ui5ol-o <br />