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' UTILITY PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICL"S <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8657 -www.everett��ra.org <br />Z� �� <br />PROJECT ADDRESS <br />�r�f <br />Property Ormer <br />���r�So� A„� <br />� <br />A1ail Address <br />Tenant Name Qf this is (or a commercial business) <br />� <br />QJGve / r'�/ <br />Crty <br />StateQip <br />;S� �°��� '�`��� ��;,�c �*-� <br />CoNrac�or Mail Atldress / ��ty <br />G�ESGLi�;�oo 727 <br />WA Slate CoMra; tor License Number (required) <br />Work to be done: <br />I� Side Sewer Repair <br />I' <br />O Side Sewer Alteration <br />❑ Side Sewer - New Installation <br />❑ Install Backwater Valve (outside the building) <br />❑ Cap oN Sewer <br />❑ Install Water Meter <br />aevisen , ��r?.am. <br />Phane <br />State2�p Phone <br />037�6s� <br />City of Everett 6usiness License Number (required) <br />FEE <br />� � °�� <br />PERMIT# <br />U 1�0�- ���I <br />