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UTILITY PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STR[ET, [VERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />�y�(� S�w� S1�✓,2P � L i/edc�-��wlA�'fB2ul <br />PROJECT ADDRESS <br />Property Owner <br />� y/D <br />tdaii Atltlress <br />Tenant Name (�f ihis is for a commercial business) <br />f`L)CVe I�ooi'f'' �%s <br />Conlractor 61a�iAdCress <br />� eSCv tC o C�1 <br />W� State Comrador icense Number (requued) <br />Work to be done: <br />�Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />Cdy <br />C�ry <br />� <br />❑ Install Backvdater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />rze rism , ins'lo,a <br />w/2 <br />Statel2ip <br />`c �✓/9- <br />State2P <br />5 � a-6-�5 <br />(f .i5o s-l� � <br />2v <br />� <br />53�7.�- <br />Phone <br />o3��sy <br />Cdy oi Everetl Business License Number (requued) <br />FEE <br />�Doc7 <br />�' •L� � /5' PERMTT# <br />a�e I I I �O�' �O� <br />v <br />