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UTILITY PERMIT APPLICATION <br />CITY OF EVERETT PE�MIT SERVICES <br />3200 CEDAR STR[ET, EVERETT, WA 98201 <br />425-257-8810 - r F1X 425-257-8857 — wv,�w.everettwa.org <br />� 3� ��i <br />I�o- Felrv �V� <br />�, PROJECT ADDRESS <br />I Lh�, s l� ���e _ <br />Property Owner M1ta:i Address C��y <br />Tenant Name Qf this is for a commercial business) <br />�J �CU��c� ��,� s �5y r'S�- .�a <br />Contractor Mad Address Cdy <br />r� -�/�S���Z - <br />N A Stale Conlraclor License Number (reqwred) <br />Work to be done: <br />� Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer - New Installaiion <br />❑ Install Qackwater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meicr <br />� <br />�,.�, .,:,:�.,,, <br />State/Zip <br />� <br />Phone <br />52�� <br />StatelZ�O Phone <br />G���� <br />City oi Everett 6usmess Licensc Number (required) <br />F[E <br />� `J�`�/ <br />PERMIT# <br />U �5���0� <br />