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UTILITY PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, `NA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everethva.org <br />PROJECT ADDR S <br />Property Owner <br />hlail Address <br />Tenant Name (If this is tor a commercial busmess) <br />�� ���� <br />Contraclor G1a�i <br />�P/��6�/�� <br />WA State ontraclor License Number (reqmred) <br />Work to be done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewei - fJew Installation <br />Qty <br />�� Ut <br />City <br />islall E3ackwaler Valve (outside the building) <br />❑ Cap off Sewer <br />� Install Water Meter <br />uF.V+5E0 �+; ��4o�a <br />Slate2ip <br />State2�p <br />Phone <br />_ y�-ol <br />Phone <br />� �� � S� <br />City of Evere�t Business License Num6er (required) <br />FEE <br />�30,°% <br />PERh1IT� <br />U I 50 °l - OCx-� <br />