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UTILITY PERMIT APPLICATION <br />� CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 9t3201 <br />425-257-8610 - FAX 425-257-8857 — www.everettwa org <br />o C� Ul �' �t -�-�, <br />PROJECT ADDRESS <br />-�'�---��--°� ��`� <br />Property Owner M17aii nddress <br />Tenanl Name Qf �his is lor a commercial business) <br />D�-!/lM �(�j �C <br />Mail <br />�-��i �'�//Pp <br />W� Slale Conirador License Number pr.quire.d) <br />Work to be done: <br />ide Sewer Repair <br />❑ Side Sewer niteration <br />❑ Side Sewer - New Installalion <br />CRy <br />❑ Install Backwater Valve (outsi�ie lhe building) <br />❑ Cap o(f Sewer <br />❑ Install Water Meter <br />��9nati�_ __ — _— <br />itl V.'.I h I I/;e^,u1J <br />;� �9-►,� �T <br />Gty Sia,elLp <br />Siale/Zip <br />� - �-o-�� <br />U�So6-i(� <br />Phone <br />Phone <br />(Z <br />--{/�� �� �� <br />City of Everetl �usmcss Lir.ense Number (required) <br />fEE <br />��,� <br />- - � ^ � v ^ � �i � PERMIl t; _ -- ---- <br />� �„� �15�(��ll�b I <br />