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UTILITY PERMIT APPLtCATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br /> 6 � a -�s <br /> 251 S OcJl�.es .�-v�, , <br /> �J iso �--�Il� <br /> PROJECT ADDRES.S <br /> �i� � �t/l�i ��� 2fp� <br /> Propei?y OwnP.r Mail Addiess Crty Slate/Zip Phone <br /> T=nant Name (If ihis is for a commercial business) <br /> .�G'��� �- �l I �-e �In�.��, �= f� � <br /> Cont�actot Mad Address Cdy StatelZip P�one <br /> 1�u r��.� � N ���l ��-Q ol�7ti' I <br /> WA State Contractor License Number(required) Clty of Everett Business License Number(required) <br /> Work to be done: <br /> J�, Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer - New Installation <br /> ❑ Install Backwater Valve (outside the building) <br /> C Cap off Sewer <br /> � Install Water Meter <br /> FEE <br /> � 3d, p° <br /> �� ���'� 6 ! Z f I� PERMIT# <br /> �Sign ture Date ' � I���� Q O� <br /> REVISEO H/I9RON <br />