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UTILITY PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREE7, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8657 — www.everettwa.org <br />171Z 5��'r, a� ���N�11 ���c�. <br />PROJECT ADDRESS <br />✓��,rl�'i f ;;vi��� 5`%/l� <br />Property Owner htaa Address <br />Tenant Name (If this is for a commercial business) <br />Coniractor t.tad Adtlress <br />WA Stale Contrador License Number (required) <br />Work to be done: <br />�( Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />A� N� _. ,,.�,,,.,.� <br />CAy <br />❑ Install f3ackwater Valve (outside tl�e building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />�ry�,�,, /—� <br />���i�ure Dale � <br />REVISFD II/�9GOIJ <br />SlatelZip <br />i <br />���a-�. <br />v�5p1-1`7� <br />yt.5 <br />State�l�p Phone <br />Phone <br />City of Everell Business License Number (required) <br />F[E <br />� O� <br />PERh1iTr <br />U �50( ��%I <br />