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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 —�w�v.everettwa.org <br />��-{ � � U i"/ [/i �t � �. �Yv"�- <br />PROJECT ADDRESS <br />�(3!tn �y17 <br />roperty Ormer M1tail Address <br />Tenan� Name (If this is for a commercial business) <br />� u u` I���,.�. �i 1. <br />Contractor <br />t�5�(S �(i% S� <br />Atlaress <br />���►'���d�if3so <br />4VA S�ate Conlraclor license Number (required) <br />Work to be done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — Ne�v Installation <br />City <br />� Install f3ackwater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />" -'� <br />AEVISEO I Vi9R0�a <br />�-�a <br />Cdy <br />SflZ�� <br />Slale/Z�p <br />Pnonc <br />� � zw ����6� <br />Slale�Z�D P�o�e <br />OS��`3s' <br />Cdy of Evereli �uslness license Number (required) <br />FEE -� <br />.�0��_ <br />PERMIT,7 <br />U150�- I� <br />� <br />