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UTILITY PIERM�T APPLIC�TION <br />CITY OF EVERETT PEFdMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - �AX 425-257-8857 — www.everetteva.org <br />Property Owner <br />Mail Addres; <br />Tenanl Name Qf this is for a commercial business) <br />City <br />��-� I <br />;�.���r-r- <br />�I—�6--��' <br />�, v �i�—oG v <br />State2ip <br />Phone <br />Contractor N�an naaress <br />�(�J✓�.( /T� <br />WA Slate CoMractor License umber (required) <br />Work to be done: <br />� Side Sewer Repair <br />❑ Side Sewer Alteration <br />L7 Side Sewer — New Instaliation <br />���r <br />❑ Install Backwater Valve (outsidc lhe buildir.g) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />� _1�Z�I � � <br />Signaturc C� aIPT <br />«���,,F�,�„�,�a,< <br />-- -- � �� ` �F�-L� ( `' <br />Y Al\�/ /i�T� <br />��� <br />City of Everelt Business License Number (required) <br />a �7 �s'� <br />f-EE — -- -- - <br />30°� <br />PERMI i!! <br />U ��� � , �C�O <br />