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UTILITY PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, GVERETT, WA 98201 <br />425-257-8810 - PAX 425-257-8857 — www everettwa.org <br />< <br />/�o l 1/r �� ;.r. w�� _�— <br />PROJECT ADDRESS <br />. <br />Property Owner <br />�I _Vl <br />Idad qddiess <br />Tenant Name (If Ihis is for a commercial busine�s) <br />Cily <br />,� _ ao �� S <br />� �SoS -o `�v <br />r}v� �'3 y - <br />z. 3/3 <br />Stale2ip � � Phone <br />� <br />�' <br />,I� f_ � �{'z-1 = � � i — <br />) C'�� V i�1/l l�J ��%i �.�-__—' �/i,i lw�/q- til �i 3 <br />Contractoi Ma�� AdCress Gty Statelb:p Phone <br />,�-� pl�/ �* a�� �n <br />WA State Contrector License Numher (requved) <br />Work to be done: <br />ide Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side 5ewer - New Installation <br />❑ Install E3ackwater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />nFwSEU r ina.loi: <br />��5�7 S S^� <br />Gty of Everett Business license Number (required) <br />FEE <br />30� <br />__ ZU—/S� rERr�r.;r <br />U l 5oS -� O� � <br />