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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 — www.everettwa.org <br />`l23/ Ile— F—//G6Gr% IAG <br />PROJECT ADDRESS <br />g-a5-i5 <br />U15012-o5(0 <br />Property Owner Mad Address City Stale/lip Phone <br />Tenant Name (If this is for a commercial business) <br />All <br />Contractor rdail Address City <br />C c A4.c A5He-857 lc-- Q <br />WA Slate Contractor License Number (required) <br />Work to be done: <br />❑ Side Sewer Repair <br />W Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />❑ Install Backwater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />1 FIW0r< <br />stale/Zip <br />City of Ever t Business License Number (required) <br />HE <br />PERMIT# <br />U ROO- 05� <br />