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UTILITY PERMIT APP�ICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX �25-25i 8�957 —www.everettwa.org <br />y!� A?vr�Un �U. -- <br />PROJECT ADDRESS <br />���ahef�e 1�N0/l�l y��� /hor.�nM %lC/' <br />Froperty Owner <br />Mad Atltlress <br />Tenanl Name (I( this is for a commercial business) <br />�N f� WP/ l!'14N7%7�h z�L01 Sw .'�ik <br />CoMrac�Or Mail Addres � City <br />SOU-TI-lf�p��C � <br />WA Slale Conlractor License Number (required) <br />Work to be done: <br />SC� ide Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />❑ Install Backwater Valve (outside the building) <br />❑ Cap off Se��er <br />❑ Insta�l Water Meter <br />REVISEO I f/19R011 <br />Cdy <br />�j���s- <br />�/ZS <br />�l- IN/� 9�za� Zi9-O?16 <br />State/Zip <br />¢ <br />Phone <br />Zo � <br />Gb �14Z-1�}�- <br />Phcne <br />�3 qb3 U <br />City of Everetl Business License Number (required) <br />FEE <br />30-0� <br />PERM[T# <br />U l� � f` �2z <br />• <br />