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r---�— <br />UTILITY PERMIT APPLICAT[O(V <br />CITY OF EVERETT PERMIT SERVICES <br />32G0 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />a.ti � � �,���.�.,, � �,,-�- <br />PROJECT ADDRESS <br />S�� k <br />Properry O�vr <br />Mail Address <br />Tenant Name (If thie, is for a commercial business) <br />City <br />� <br />�r��� ���, <br />Stalc2iD Phone <br />j�i ��n l�lU�,l,��� f7 s� S y ��� st� Si= S�+�G��..� cl, �✓� �i�7_�� y.2S 7���GD <br />Contractor (/Ma;lAdtlress Gry StatelZip Phone <br />r���'u^ P���- �SF� 3 5 0 <br />�NA State CoNractor License Number (required) <br />Work to be done: <br />❑ Side Sewer Repair <br />O Side Sewer Aiteration <br />❑ Side Sewer — New installation <br />f�: Instali [iackwater Valve (outside the building) <br />❑ Cap off Sewer <br />7 Instali Water Meter <br />�_ <br />REVISED 11/14201< <br />��'��IS� <br />OS>63 S <br />Ciry of Everelt Business l.icense Number (required) <br />�O p0 <br />PERMIT# <br />U 1� (a- 01`� <br />