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UTILITY PERMIT APPLICATION <br /> C17Y OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org <br /> �3._.�q �i � r� � <br /> PROJECT ADDRESS <br /> 1M :{�e � � u� S 3�� ��e��l� ��, � x � �' � 03 4a3 0� <br /> Propefty0vmef h7ailAddress Cily State/'L�p Phone I <br /> I <br /> Tenanl Vame(If ihis is for a commercial business) <br /> �,9.. p(�� l-�-t ? 9.���5 �v��t" �9�. 4��0� ���3� <br /> Coniract_� tdailAdtlress City State/Zip Phone <br /> �-{�� l�/�S�I c��5 VVt q � � � 3 � <br /> 1NA State Contraclor License Number(required) City of Everetl Business License Number(required) <br /> Work to be done: <br /> Side Sewer Repair <br /> O Side Sewer Aiteration I <br /> ❑ Side Sewer — New Installation <br /> ❑ Install E3ackwater Valve (outside the building) <br /> ❑ Cap off Sewer <br /> O Install Water Meter <br /> FEE <br /> �� pD <br /> �� � � �- 3 - <br /> �.tC r PERMIT# <br /> � Dale U ([�]O L � OV� <br /> ✓ <br /> �EL��S-"O rvi�:pr: <br />