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UTILITY PERMIT APPLICATION <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 />.��IoB ����Ile�. A�� <br />PROJECT ADDRESS � <br />���, ( <br />�11_ <br />Property Ovrner <br />' V /� <br />N c(If this is lor <br />u `v �`� <br />��✓ : <br />�,1ad Adtlress <br />commerc�al business) <br />�� 23 <br />� 2 ��+� C-�-. _ � <br />COniraCiOr / Mail Address / ���Y <br />��s�ss ��"�-- �� <br />WA State CoNractor �icens�N �mber (required) <br />Work to be done: <br />❑ Side Sewer Repair <br />O Side Sewer Alteration <br />❑ Side Sewer - New Installation <br />� Install Hackwater Valve (ou?side the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />� <br />RC'VISED 1viPGON <br />Cuy I <br />� �, Y <br />ya�- <br />� ��� <br />StatelZip / Phone <br />Pho^e <br />��1�� <br />City of Fverett Business License Number (required) <br />FEE <br />3�� <br />PeRr•�rrx <br />U l S b5-o � <br />