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UTILITY PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES 6`� _ � S <br />3200 CEDAR STREET, EVERETT, WA 98201 p <br />425-257-8810 - FAX 425-257-8857 — v✓ww.everettwa.org �J 1 50 6—� I <br />�.�/O� � /�u�C<<�ev ��ucQ <br />PROJECT ADDRESS <br />��'i S�'an /�ouns�,/ �.�� 3rr,� 5� /�ia4� f{t� �%� <br />Property OHmer <br />Mail Atldress <br />TenaN Name Qf this is for a commercial business) <br />Gy <br />Ho�nepwner <br />CoMtaClor Mail Atldress Gly SlatelZip <br />Contractor License Number (requued) <br />VVork to be done: <br />QQ Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />C1 Install Backwater Valve (outside the building) <br />❑ Cap off Sewer <br />O Install Water Meter <br />D <br />RFNSFO i V19r01J <br />SlalelZip <br />� <br />Phone <br />Phone <br />City of Everelt Business License Number (reqwred) <br />r/2o� <br />�30.00 <br />PFRMifi! <br />U I ��lV_ �V I <br />