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UTILITY PERMIT APPLICA � ION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREE7, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 —www.everettwa.org <br />�,o�� N%1 S�i�1,�. <br />PROJECT ADDRESS <br />P� <br />Owner <br />tdail <br />Tenant Name pf this is for a commercial business) <br />�� x� <br />Con,ractor 1.1, d Address <br />�� �c� I �"lg ��j <br />W� Stale Contrector License Number (required) <br />Work to be done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer - New installation <br />C�ly <br />❑ Instal! C�ac��.vater Valve (outside the building) <br />�Cap off Sewer <br />❑ Install Water Meter <br />'/) � <br />FFP�SCD f1iiA:b1� <br />C�ty <br />SlalelZip <br />Pro�e <br />StatdLp Phone <br />� L/ J����.—_ <br />City o� Evcretl 6usiness License Number (required) <br />FEE <br />����b� <br />PERMIT�t <br />U 15 D(� -b3� <br />