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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 - wv✓w.everettwa.org <br />��o� ��c�Ce�el(��� <br />PROJECT ADDRESS <br />f'ropery <br />Ida i <br />.� <br />Tenant Name Qf this is (or a commercial business) <br />I+tad AdCress <br />_S��-t-�- � � G I�b �-� <br />WA Slate Coniraclor License NumGer (required) <br />Work to be done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer - New Installation <br />Ctly <br />�Install [3ackwater Valve (outside U�e building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />REv�SED I v�9?Ota <br />`�c�_C_��� I 1�� � I�� <br />Ci;y <br />StatelZ�p Phone <br />a�-��7�. <br />O`W -�7.M—� W� <br />SIatMLp Phone <br />� l � <br />City of EvereU Business License Num6er (required) <br />FEE <br />PERh1IT« <br />U � 5p�'- )10 <br />