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UTILITY PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - �AX 425-257-8857 —www.everettwa.org <br /> � <br /> / �3v G�/�5 G�-P <br /> PROJECT ADDRESS <br /> ��� Q> ,�� , ��/�s <br /> PrOperiy Owner Mail Address City State2ip. Phone <br /> Tenant Name pf this is for a commercial busmess) <br /> � ° �� / 2cx�- �°-7/,� <br /> ConVBclor Mail Address City Slalc2ip Phone <br /> ��� o��,�� �j l� 1�iI � �� ,� �l� <br /> WA State Contractor License Num er(required�— City of Everett Business License Number(required) <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer — New Instaliation <br /> nstall [3ackwater Valve (outside the building) <br /> O Cap off Sewer <br /> ❑ Install Water Meter <br /> FEE <br /> -- . _ . 3D °o <br /> ��" � —�� PERMIT,Y <br /> Signalure Date � ������� <br /> FEl95ED 1Vf?/201a ' <br />