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UTILITY PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERElT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />aa�. ��,�r �v� _ <br />PROJECT ADDRESS <br />i�r�.n�d� i�n5�o� a,�a- �u�ril�lf <br />Property Owner Mail Address <br />Tenant Name (If Ihis is for a commercial business) <br />I <br />Contractar Mail Address <br />�,d�, �sc �,aa � � <br />alA Stale ConUactor License Number (required) <br />Work to be done: <br />�Side Sewer Repair <br />❑ Side Sewer Alleration <br />❑ Side Sewer — New Installation <br />�-��-�5 <br />t;� I50 �— ! � �o <br />ft�� K��`� lUG <br />City Stale/Zip <br />— P <br />it�.��una l� lvc� !�c, �Cc,ui l�a I.0 <br />City Slale2ip <br />❑ Install Backwater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />urw.tio-n iinelro�a <br />Phone <br />as 3�J� 8`�g i <br />[t� <br />Phone <br />o3�7a� <br />City of Everett Business License Number (required) <br />FEE <br />�� �DD <br />PERMITIt <br />11 � 50(0 - /((o <br />