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UTILITY PERMIT APPLICATION <br />CITY OF EVcF::"iT PERMIT SERVICES <br />3200 CEDAR STREET, EVE{.El-f, WA 98201 <br />425-257-8810 - FAX425-257-8857—www.everettwa.org �.,�(�_�� <br />,��.. q�o,�.3 <br />PROJECT <br />(} 150�-DI� <br />_7'n.,� ,���.: .�-, �_�u SQr�,2 <br />PropeAy Owner Mail Address City Slate/Zip Phone <br />Tenant Name pf lhis is for a commercial business) <br />Contractor Mail Address <br />R�s�� .����z <br />WA State Gontractor License Numbe� (required) <br />Work to be done: <br />�: Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />City <br />❑ Install Backwater Vaive (outside thc building) <br />U Cap off Sewer <br />❑ Install Wate� Meter <br />��/'_ 7�� <br />l�J�� C/ `- <br />ucvrSLD � �/19no�a <br />StatelZip <br />t'z1�Z3 ��� <br />�ily ol Everelt Husiness License Number (required) <br />I`Et= --- -- <br />� �j0, a% <br />-- -�j `�l'l PERMTTt1-- — <br />��atc v I��V�OI I <br />