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UTILITY PERMIT APPLICA.TION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVFRETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />4�1�� �( L����� <br />PROJECT ADDRESS <br />S L��' � � <br />Mail Address <br />Tenanl Name (If fhis is for a commercial business) <br />�.-{�g�-� ,�... -�1�� L�-t � 9 J �= <br />Contractor Mail Address City <br />�{�� ►�,s�r�c�s w� q <br />WA State Ccntraclor license Number (reqwred) <br />Work to be done: <br />�Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />❑ Install Backwater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />� <br />REVISED I I/19(Ni� <br />S <br />State2ip <br />E �RT hJa�. �R o�� �t �� <br />� Slate�Zip Phone <br />����q�3 <br />City of Everett Business license Number (required) <br />FEE <br />�jp .00 <br />�Q_ � � PERMIT# <br />. U f�0('ol8 <br />� <br />0 <br />