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UTILITY PERMIT APPLIC/�TIOIV <br />CITY OF EvGRETT PERMIT SERVICES <br />3?.00 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />� �'/D� �n/a N,'ec,/ �31a� 9�J� <br />PROJECTADDRESS <br />�✓%tY�! CJ�oe'd'r%' Z`�lDs Pq�q�ci./i3�ud �7/�d'�y'l (,J� ��ov9 <br />PropeRy Ownef Mail Address City StatelZip Phone <br />Tenant Name (If �his is for a commercial business) <br />Conlractor Mail Address <br />RcS � �OD / c�i ^i <br />WA State Contractor License Number (required) <br />Work to be done: <br />� Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer - New Installation <br />City <br />❑ Install Backwater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />REVISEO f i/19QOfa <br />StatelZip <br />City of Everett Business license Number (required) <br />FEE <br />PERMIT# <br />� j 50l -o�{S <br />